Anorectal Abcess

Question 1

What is anorectal abscess?

Answer 1

• collection of pus in anal or rectal region
• more common women

Question 2

What is the px of anorectal abscess?

Answer 2

1. plugging of anal ducts
2. prevent anal glands from being drained
3. fluid stasis
4. infection

Question 3

What are the common organisms that cause anorectal abcess?

Answer 3

• e.coli
• bacteriodes spp
• enterococcus spp

Question 4

Where are anal glands located in the anus?

Answer 4

Intersphincteric space

*but when infected, abcess will spread to adjacent locations

Question 5

What are the 4 areas where anorectal abscess occur

Answer 5

• Perianal (most common)
• Ischiorectal
• Intersphincteric
• Supralevator

Question 6

What are the clinical features of anorectal abscess?

Answer 6

• pain in perianal region - exacerbate when sitting down
• localised swelling
• pruritis
• discharge

If severe abcess, include

• fever
• rigors
• general malaise
• sepsis

Question 7

What will you find on examination for perianal abscess?

Answer 7

• erythematous, fluctuant, tender, perianal mass
• +/- surrounding cellulitis
• discharging pus
• severe tenderness on DRE

Question 8

What is the Mx for perianal abscess?

Answer 8

Initial Mx

• abx
• analgesia

Surgery (main management)

• incision and drain (under general anaesthesia)
  
  • heal by secondary intention after
• protoscopy - to check for fistula in ano
  
  • if fistula present - seton insertion