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Anorectal abscess lecture note

Anorectal abscess is a painful infection of the soft tissues around the anus and rectum, often caused by bacteria like Staph aureus. It is most common in males ages 30-40. The infection can develop in various locations - intersphincteric, perianal, ischiorectal - depending on which anal glands or sinuses become blocked and infected. Clinical features include pain, swelling and fever. Treatment involves incision and drainage of the abscess followed by antibiotics and dressing changes to prevent complications like fistula formation.

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G B O N E M E S . E ANORECTAL ABSCESS
OUTLINE • Introduction • Epidemiology • Relevant Anatomy • Etiology • Classification and Pathogenesis • Clinical Features • Management
INTRODUCTION AND DEFINITION • Anorectal Abscess can simply be defined as infection of the soft tissues surrounding the anal canal and the rectum with formation of an abscess cavity. • It is of importance as it may lead to complications which includes fistula in ano.
EPIDEMIOLOGY • Age: 3rd and 4th decade • Sex: Affects more males than females • Race: No racial predilection • Commonly found amongst the immunosuppressed.
RELEVANT ANATOMY
RELEVANT ANATOMY CONTD • Anal Columns (longitudinal)are attached by Anal Valves(Horizontal) to form Anal Sinuses which drain into the Anal glands located in the intersphincteric zone. • At the area of the Anal Sinuses lies the pectinate/dentate line. • Dentate line acts as a boundary for the rectum and the anal canal
ISCHIORECTAL FOSSA • Pyramidal structure • Apex- towards the Pubis symphysis • Roof- Levator Ani Muscle • Lateral Wall: Obturator internus muscle and fascia • Medial: Medial part of ischial tuberosity
ETIOLOGY AND RISK FACTOR • Etiology: Common organisms include Staph Aureus, Streps, Bacteroides. • Other causes include: Crohn’s disease, ulcerative colitis, Tuberculosis, STD’s, appendicitis. • Risk Factor: Immunosuppression, Malignancy, Trauma, Radiation therapy.
CLASSIFICATION • Classified into 5 • 1. Intersphicteric Abscess • 2. Perianal Abscess • 3. Ischiorectal Abscess • 4. Pelvirectal Abscess • 5. Submucous Abscess
CRYPTOGLANDULAR THEORY • Anal Sinuses drain into the crypts around the dentate line, these crypts drain into the anal glands at the intersphincteric zone, hence the intersphincteric abscess is usually the starting point. • Suppuration of the Anal Pile – Perianal Abscess
CONTD • Suppuration of the Ischiorectal fossa – Ischiorectal abscess. (usually due to the presence of poorly vascularized fat) • Intersphincteric abscess extends laterally through the anal sphincter. • It may communicate posteriorly to form a HORSE SHOE abscess.
CONTD • Submucous Abscess: Suppuration above the dentate line. Responsible for 5% • Pelvirectal: Suppuration above the Levator Ani muscle. Can occur due to intersphincteric abscess or a pathology in the pelvis or abdomen e.g Appendicitis.
CLINICAL FEATURES • Patient presents with: • Pain which may be in the perianal region or in the anorectum (seen in submucosa abscess) • Fever • Swelling which may be discharging or is ulcerated.
CONTD • Signs Include: • Tender, Smooth swelling • Soft if Perianal, Hard if ischiorectal • Patient is febrile and generally unwell.
MANAGMENT • Investigations: • DRE • USS : Shows and abnormal collection • CT • MRI • CT and MRI used to identify the cause in Pelvirectal • PUS culture – M/C/S
MANAGMENT • Treatment: • Analgesics for the pain • Incision and drainage of the Abscess, followed by appropriate ANTIBIOTICS based on selectivity. • Incised area should be packed with sterile gauze and dressed twice daily. • Stool softeners should be given to avoid constipation which may worsen the problem.
COMPLICATION AND CONCLUSION • Complications include: Fistula in ano, Founier’s gangrene, Anal fissure and Overwhelming sepsis. • In conclusion, abscess must be drained before antibiotics is administered.