IGNORE AFTER THIS [31] Anorectal Abscess Flashcards
What is an anorectal abscess?
A collection of pus in the anal or rectal region
Which gender are anorectal abscesses more common in?
Men
What are anorectal abscesses thought to be caused by?
Plugging of the anal ducts
What are the anal ducts?
Structures found in the wall of the anal canal which drain the anal glands
What do the anal ducts do?
Secrete mucus into the anal canal to ease the passage of faecal matter
What does blockage of the anal ducts cause?
Stasis
What does stasis caused by the blockage of the anal ducts allow?
Normal bacterial flora to overgrow, leading to infection
What are the common causative organisms for infection in anorectal abscesses?
E. Coli
Bacteroides
Enterococcus
Where are the anal glands located?
In the intersphincteric space
What is the intersphincteric space?
The space between the internal and external anal sphincters
What can happen once infection has started in the anal glands?
Infection can spread to adjacent areas
What can anorectal abscesses be classified on the basis of?
Where they occur
What are the classifications of anorectal abscesses?
Perianal
Ischiorectal
Intersphincteric
Supralevator
What course do anorectal abscesses take?
They are typically intermittent in nature
How do anorectal abscesses present?
Pain in perianal region, which is exacerbated when sitting down
Localised swelling, itching, or discharge
What symptoms might be caused by severe anorectal abscesses?
Systemic features, such as fever, rigors, general malaise, or sepsis
What will be found on examination in anorectal abscess?
The abscess will be red and tender, and may be discharging purulent or haemorrhagic fluid
Likely be some degree of surrounding cellulitis
How is a diagnosis of superficial anorectal abscess made?
Clinically
What will DRE often reveal in anorectal abscesses?
Fluctuant tender mass
What is the limitation of DRE in anorectal abscess?
Many patients cannot tolerate this, and require examination under anaesthesia
What investigation might complicated or chronic anorectal abscesses require?
Imaging, typically MRI
Which anorectal abscess patients are systemic features more likely to occur in?
Patients who are immunocompromised
Those with ischiorectal abscesses
Why is there little room for conservative management of anorectal abscesses?
As they have high rates of recurrence and the development of fistulae
What is the role of antibiotics in anorectal abscesses?
Antibiotics may be utilised initially for acute infective states, especially in diabetes or immunocompromised patients, but should not be used routinely
What is the main management of anorectal abscesses?
Surgical drainage
Is surgical drainage of an anorectal abscess typically performed under local or general anaesthesia?
General
Why should drainage of an anorectal abscess be performed in a timely manner?
To prevent tissue damage, including anal sphincter dysfunction
How do anorectal abscesses heal following drainage?
Secondary intention
Should there ever be an attempt for early closure of an anorectal abscess?
It is not advised
What may be considered by experienced surgeons in anorectal abscesses?
The insertion of a seton
When is the insertion of a seton performed in anorectal abscess?
Typically only if the tract is identifiable with minimal probing
