University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

359

Pages:

3
Author:

Mariam A. A.

Anorectal abscess Definitions • • • • Localised infection with a collection of pusses in the anorectal area. - Usually from invasion of normal rectal flora. The abscess can occur anywhere in the above anatomy. Can be deep or superficial. Types of abscesses: - If between internal and external sphincter -> inter-sphincteric - If just below the skin and confined to superficial subcutaneous layer i.e. downwards between the sphincters and towards the anal verge -> subcutaneous/perianal abscesses -> most common -> accounts for 80%. - If large from superficial to the deep -> ischiorectal. - Above the levati ani muscles -> supralevator Signs and symptoms • • • • Severe pain, especially when sitting. - Not necessarily with bowel movement -> can happen whenever. Fever Malaise Purulent discharge • Physical examination: - Patient should be in perirectal exam position: laying on the side with knees up on the chest -> relieves the anal area. - Area of flatulence or path or erythematous indurated skin within the buttocks area. - May also do a DR -> examines for any deeper abscess -> do this if there is a susception of a deeper abscess, following a general examination. Diagnosis: • History and physical examinations -> see above. Pathophysiology Anal crypt gland (roughly situated along the pectinate line and are tiny mucus glands of lubrication -> just before bowel movements the sphincter muscles contract to allow squeezing for lubrication) -> from the crypts the bacteria can spread from the anal ducts and then infect the glands -> the infection from here can spread nearly anywhere where there is least resistance -> can spread submucosally, subcutaneously and trans-sphincter and surrounding the tissue. • As a general rule the abscess can collect in every anatomical space where the glands terminate or whichever path of least resistance. Differential diagnosis • • • • • Pilonidal cysts Hidradenitis supprativa Bartholin duct abscess in females External haemorrhoids Fistula in anal Management and Treatment • • • Drainage under local anaesthetics Antibiotics for groups at risk Fistula can be identified using an anoscope: - Injecting fluids through a visible external opening and seeing where the fluid comes out from within the anal canal. - If identified management includes drainage Complications • • • Spreading to other tissues Inter-sphincter abscess Fistula development - 50% of patients will develop -> hence accessing for this and managing is important.