Anorectal Abscess

Question 1

What is the defn on an anorectal abscess?

Answer 1

infxn of the anal glands in the anal crypts at the dentate line. Intially occ in inter-sphincteric space then can spread:
Superficial to ext sphincter -> perianal space
thru ext ephincter -> ischiorectal space
deep to ext sphincter -> supra-levator space

Question 2

How does a pt w/ an anorectal abscess present clinically?

Answer 2

pain in perianal area - classically dull, aching/throbbing, worse on sitting down + right before a bowel mvt
O/E - small, erythematous, well-defined, fluctuant, subcutaneous mass near the anal orifice

Question 3

How do you classify an anorectal abscess?

Answer 3

perianal (60%)
ischiorectal (20%)
inter-sphincteric (5%)
supra-levator (4%)

Question 4

How do you tx an anorectal abscess?

Answer 4

Surgical drainage
+/- antibiotics if: pt immunocompromised; diabetic; has extensive cellulitis; = valvular ds
Post-op: analgesics, stool bulking agents + stool softners

Question 5

What are the complications of an anorectal abscess?

Answer 5

Sepsis

Anal fistula - 40% pts develop chr fistula