Ano-rectal sepsis

Question 1

What causes ano-rectal sepsis?

Answer 1

anorectal abscess due to associated necrotising soft tissue infection

Question 2

Presentation

Answer 2

•perianal swelling
•low-grade fever
•tachycardia
•change in bowel habits
-?urinary retention

Question 3

RF

Answer 3

• anal fistula
• Crohn’s disease
• male sex
• hard stools

Question 4

Investigation

Answer 4

clinical diagnosis w/ examination

On occasion, examination without anaesthetic may be impossible because of pain. Inter-sphincteric and supra-levator abscesses in particular may require anaesthesia for full examination.

Question 5

Treatment

Answer 5

surgical drainage
Perianal abscesses using local anaesthesia and drained externally in A+E.

Perirectal abscesses should be drained in the operating room

Inter-sphincteric and supra-levator abscesses
general anaesthesia for an adequate anal examination for diagnosis and to drain the abscess.
drained internally into the anal canal and rectum

Question 6

Post-operative care

Answer 6

Patients should begin baths with comfortably warm water 2 or 3 times daily postoperatively to clean the wound until healed.
Warm water baths should also be used for cleansing after bowel movements.

Prevention of hard stool formation too

Question 7

What medical treatment if elderly etc?

Answer 7

Triple therapy

• amox
• met
• gent