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Anorectal abscess

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Anorectal abscesses

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Anorectal abscess

  1. 1. Anorectal abscess By Vivek Ghosh Intern Dept. of General Surgery, GMCTH 7/6/2017 1
  2. 2. Presentation outline • Case presentation • Introduction & Etiology • Classification • Clinical features • Investigations • Treatment 7/6/2017 2
  3. 3. Case • 28 yrs./Male with swelling in the right buttock for 8 days, which gradually increased in size • Pain over the area, throbbing type, continous, non-radiating, associated with local rise of temperature • No h/o local trauma, discharge from the swelling • No h/o fever or vomiting • Past History: No h/o similar episodes in the past No known h/o any chronic illness till date On Examination: GC: fair Vitals: Stable Systemic Examination: Normal Local examination: Swelling about 3x2 cm. in size on right buttock, lateral to anal opening Local temperature raized Tenderness + Erythematous Induration + 7/6/2017 3
  4. 4. Case(contd…) • Investigations: Blood parameters all within normal limits Serology: negative • Provisional Diagnosis: Perianal abscess (Rt) • Treatment: Incision & Drainage under IVA • Operative findings: Ischiorectal abscess- about 10 ml of pus was drained • Final diagnosis: Ischiorectal abscess(Rt) • Patient discharged on 2nd POD 7/6/2017 4
  5. 5. Anorectal abscess • Acute anorectal suppuration • Etiology:  Cryptoglandular (95%)  Infection : E.coli(60%) , Staph., Strep. , Bacteroides  Irritation : Crohn’s disease, ulcerative colitis, FB  Immune compromised state : DM,AIDS,malignancy  Others : TB, STDs, Radiation therapy, 7/6/2017 5
  6. 6. Classification 1. Perianal (60%) 2. Ischiorectal (30%): extension laterally through the external sphincter 3. Submucous(5%) 4. Pelvirectal : situated between the upper surface of the levator ani and the pelvic peritoneum 7/6/2017 6
  7. 7. Epidemiology • Peak incidence: 3rd and 4th decades of life • Men are affected more frequently than women are, with a male-to-female predominance of 2:1 to 3:1 7/6/2017 7
  8. 8. Clinical features • Perianal discomfort/ pain- throbbing/ aching • exacerbated by movement and increased perineal pressure from sitting or defecation • Perianal swelling • Perianal abscess usu. presents early(2-3 days) whereas ischiorectal abscess usu. presents later • Ischiorectal abscess often presents with high grade fever with chills and rigor 7/6/2017 8
  9. 9. On examination • Perianal swelling: Tender, erythematous, fluctuant, warm • DRE: a fluctuant, indurated mass may be encountered • Fluctuation may not be present in ischiorectal abscess (late feature) 7/6/2017 9
  10. 10. Investigations • Clinical diagnosis • Investigations relevant to specific causes • When abscess is not obviously apparent but a high degree of clinical suspicion exists Ultrasound, CT scan and MRI may be helpful • Pus culture 7/6/2017 10
  11. 11. Treatment • Early surgical drainage of the purulent collection • Primary antibiotic therapy alone is ineffective • Any delay : augments tissue damage, may impair sphincter continence function, promote stricture and/or fistula formation 7/6/2017 11
  12. 12. The gauze is removed after 24 hours, and the patient is instructed to take sitz baths Pus is collected and sent for culture. Hemostasis is achieved with manual pressure, and the wound is packed with iodophor gauze. A cruciate incision is made over the most fluctuant point, with excision of skin edges to deroof the abscess 7/6/2017 12
  13. 13. Post operative • Analgesics • Stool softners • Antibiotics • follow up: 2-3 weeks for wound evaluation and inspection for possible fistula-in-ano. 7/6/2017 13
  14. 14. • Pelvirectal abscess:  Diagnosis and treatment of underlying pelvic pathology Drainage of pus through the rectum or through posterior fornix in females 7/6/2017 14
  15. 15. Take home message • Anorectal abscess usually produce throbbing pain, swelling in the anal region. • Anatomically classified as perianal, ischiorectal, submucous and pelvirectal abscess. • Primary modality of treatment is drainage of pus with analgesics and appropriate antibiotics • Underlying problem should be looked for and adequately treated 7/6/2017 15
  16. 16. References 1. Bailey & Love’s Short Practice of Surgery, 26th Edition 2. Manipal Manual of Surgery, K.R. Shenoy et al, 4th Edition 3. SRB’s Manual of Surgery, S. Bhat M, 4th Edition 4. Beard JM, Osborn J. Anorectal Abscess. Rakel RE, Rakel DP, Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders; 2011 7/6/2017 16
  17. 17. 7/6/2017 17

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