Anorectal Abscess (गुदामार्ग के पास फुंसी) Cause, Symptoms, Diagnosis, t/t || Dr. Shipra Mishra ||
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- čas přidán 22. 08. 2023
- #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.
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.
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Sure
In America, treatment of perianal abscess is an episode of doctor pimple popper. It is not in the attitude to break skin when you don’t have to. Abscesses can be left to heal by themselves. A growing abscess can warrant treatment.
Lmao, many people without chrohns or IBD are having abscesses lanced and are now seeking plastic surgeons for scar treatment. It could have been left alone