Gen Surg: Anal fistulas, abscesses, fissures and cysts Flashcards
What isa perianal fistula?
Abnormal connection between the anal canal and perianal skin
What is the relationship between anorectal abscess and perianal fistula
Around 25-40% of abcesses lead to fistular formation
What is an anorectal abscess?
Collection of pus in the anal or rectal region
Who is most affected by anorectal abscesses
20-60 y/o
Men
What are the causes of anorectal abscess?
Infection in cyrptoglandular epilithelium
Crohns
How would a patient with anorectal abscess present
Severe throbbing or stabbing pain, localised swelling, itching or discharge
fever, malaise, constipation , bleeding
What are the sites for anorectal abcesses
Supralevator
Ischiorectal
Ischiosphincteric
Perianal
What is the most common site of an anorectal abcess
Perianal
What would you find on examination of a perianal abscess
Erythematous, fluctuant, tender perianal mass.
How do you a treat a perianal abscess?
Incision and draining, either using a cruciate or elliptical incision. Then proctoscopy should be performed to check for fistula
When would you prescribe IV antibiotics for an anorectal abscess
I.v antibiotics indicated in the following situations:
Immunosuppressants
Valvular heart disease
Prosthetic devices
Sepsis or extensive cellulitis
Crohns disease
What are the risk factors for perianal fistula ?
IBD
Systemic diseases
History of trauma
Previous radiation therapy
What is a complex perianal fistula?
above or passing through the external sphincter, involving > 30%
How does a perianal fistula present?
Hx of recurrent abscess
leaking faeces
Pain
What would you see on examination of an anorectal fistula
External opening visible
Erythema
Proctoscopy–> internal opening