Anorectal Abscess

Question 1

What is an anorectal abscess?

Answer 1

Abscess arising from the cryptoglandular infection that results in suppuration

Question 2

What is the pathophysiology?

Answer 2

Infection of anal glands in the anal crypts at the dentate line.
Initial abscess occurs in the intersphincteric space then can spread
- Superficial to the external sphincter: Perianal space
- Through the external sphincter: Ischiorectal Space
- Deep to the external sphincter: Supra-levator space

Question 3

What is the clinical presentation?

Answer 3

1. Pain and swelling in perianal area
2. Fever
3. Erythematous, palpable swelling, fluctuant, subcutaneous mass near anal orifice, indurated tender perianal swelling
4. DRE: Fullness in posterior anal canal, exquisite tenderness

Question 4

What is the anatomical classifications of anorectal abscesses?

Answer 4

1. Perianal
2. Ischiorectal
3. Intersphincter
4. Pelvirectal/Supralevator
5. Others - submucosa, intermuscular

Question 5

What is the treatment?

Answer 5

1. EUA and I&D, send pus for culture; commonly E. coli, staph
2. Assessment of underlying fistula
3. Document any presence of internal opening
4. Antibiotics (+/-) if pt is immunocompromised, DM, extensive cellulitis, valvular heart disease
5. Postop analgesia, stool bulking agents and stool softeners, sitz bath

Question 6

What are the complications?

Answer 6

1. Sepsis
2. Anal Fistula