#anorectalabscess, #analdisease #gudamargfunsi #anorectalabscesstreatment
Ano-rectal Abscess
Most common causative organism is E. coli (60%). Others are Staphylococcus, Bacteroides, Streptococcus, B. proteus. Commonly occurs due to infection of anal gland in perianal region. 95% of anorectal abscesses are due to infection of anal glands in relation to crypts-cryptoglandular disease. Common in diabetics and immunosuppressed.
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Other causes:
Injury to anorectum.
Cutaneous infection (e.g. Boil).
Blood born infections.
Many anorectal abscesses are associated with anal
fistulas.
Fissure-in-ano.
Perianal haematoma.
Post-anorectal surgery.
Crohn‘s disease.
Tuberculosis.
Classification-
Supra levator Abscess
Inter sphincteric Abscess
Ischiorectal Abscess
Perianal Abscess- Submucosal Abscess
Sub cutaneous
Investigations
x MRI is the investigation of choice for anorectal abscess.
x Perineal and anal US is also very useful.
x Investigations relevant to specific cause may be done.
x Proctosigmoidoscopy is needed to identify secondary cause
in anorectum.
Perianal Abscess (60%)
x This usually results due to suppuration of anal gland or
suppuration of thrombosed external pile or any infected
perianal condition.
x It lies in the region of subcutaneous portion of external
sphincter.
Clinical Features
x Severe pain in perianal region with difficulty to sit.
x Tender, smooth, soft swelling in the region.
Treatment
x Sitz bath, antibiotics, analgesics, local application of anaesthetic agents and laxatives.
x Drainage under G/A.
Ischiorectal Abscess (30%)
Surgical Anatomy
Ischiorectal fossa (pyramidal shape 5 cm depth and 2 cm width)
lies between anal skin and levator ani. Right and left communicates
with each other. Laterally, it is related to fascia covering obturator
internus; medially to levator ani and external sphincter; posteriorly
sacrotubercous ligament and gluteus maximus; anteriorly urogenital
diaphragm; below, the floor by skin. Above it is related to lunate fascia
and pudendal neurovascular bundle in pudendal canal (Alcock’s canal).
Causes
x Commonly, it is due to extension of low intermuscular anal
abscess, laterally through external sphincter.
x But often it can be blood or lymphatic born.
x Fat in the fossa is more prone for infection because it is
least vascularised.
x Fossa communicates with that of opposite side through postsphincteric space and so horse-shoe like abscess can occur.
x It presents with tender, indurated, brawny swelling in the
skin over the ischiorectal fossa with high fever.
x Swelling is not well-localised and fluctuation is absent in
ischiorectal abscess.
Treatment
Under G/A in lithotomy position, through a cruciate incision a
portion of skin is excised (de roofing) and pus is drained. Pus is
sent for C/S and presence of any internal opening to rectum should
be looked for (for possibility of an existing fistula).
Submucous Abscess (5%)
x It occurs above the dentate line, which can be drained with sinus
forceps, through a proctoscope.
x Aching pain in the anorectum with significant perineal discomfort.
x On digital examination (P/R), tender, soft, smooth swelling in the
lower rectum and anal canal.
x It may be missed clinically as there is no obvious swelling externally.
x Treatment is proper antibiotics; incision and drainage under general
anaesthesia.
22 авг 2023
