Anorectal Abscess Fistula Flashcards
Def of anorectal abscess
Acute putulent collection in the perirectal area, can progress to form fistula
Specific Etiology of ano rectal abscess
. Inflammatory bowel disease (Crohn’s disease, Ulcerative colitis)
Infection (Tuberculosis, Actinomycosis, Lymphogranuloma venereum)
Trauma (Impalement, Foreign body, Surgery, Episiotomy, Hemorrhoidectomy, Prostatectomy)
Malignancy (Carcinoma, Leukemia, Lymphoma, Radiation)
Types of ano-rectal abscess
“1 inter-sphincteric
2. Peri anal
3. Supra-levator
4. Ischio- rectal
CIP of ano -rectal abscess
General: headache I hectic fever l anorexia l malaise
Local: hotness, redness, tender l edema
Diagnosis In ano-rectal abscess
- History & symptoms
- inspection & palpction
- imaging → in selected cases
DRE in ano-rectal abscess
Palpable swelling
Pain at pressure/touch
Treatment of ano-rectal abscess
. Incision and drainage
NB: don’t wait until fluctuation occur
Classification of ano-rectal fistula
a) intersphincteric,
(b) transsphincteric,
(c) suprasphincteric,
(d) extrasphincteric.
Symptoms of a-r fistula
• Is characterized by chronic complaints and discomfort.
• Secretion; which varies in intensity and is often accompanied by anal eczemas.
Sign in a -r fistula
• Inspection of the external opening (usually easily perceptible)
• If the external opening is epithelialized, in this case it is temporarily closed, but the fistula
itself does not heal completely.
• By digital rectal examination, the internal opening could be located (at the dentate line,
difficult), and the fistula track could be palpated as a string-like structure.
Most important investigation in a-r fistula
MRI fistulogram
Goals of surgical TTT in a-r fistula.
. 1. Elimination of sepsis.
2. Closure of the fistula track.
3. Preservation of patient’s fecal continence and sphincter function.
4. Minimizing recurrence.
TT T of complex fistula
Lay open + sphincter reconstruction
Lay open + seton
Flap
TTT of Simple fistula
Lay-open
