Perianal Abscesses/Fistulae Flashcards
What is a perianal abscess?
collection of pus within the subcutaneous tissue of the anus that has tracked from the tissue surrounding the anal sphincter
Who tends to get perianal abscesses?
More common in men (2:1)
Average age is 40
What are the presenting features of a perianal abscess?
Pain around the anus, worse on sitting
Hardened tissue in anal region
Pus-like discharge
Signs of systemic infection if lonstanding
What causes perianal abscesses?
Gut flora - E. coli
Skin infection -Staph. A
What investigations are done to diagnose perianal abscesses?
DRE
What investigations are done to find the cause of a perianal abscess?
Colonoscopy
Blood tests/cultures
Inflammatory markers
Imaging rarely used
MRI - gold standard for anorectal abscesses
US
What are some associated conditions for perianal abscesses?
Crohn’s
DM (wound healing)
Malignancy
What is the treatment for perianal abscesses?
Surgical incision and drainage
ABs is systemic upset
Define fistula
Abnormal connection between two epithelial surfaces
What GI conditions commonly cause fistulae?
Diverticular disease
Crohn’s
What are the two types of fistulae involving the gut?
Enterocutaneous
Enteroenteric or Enterocolic
What is an enterocutaneous fistulae?
link the intestine to the skin
When can fistulas form?
spontaneous rupture of an abscess cavity onto the skin (such as following perianal abscess drainage)
What are some rules for fistula management?
If no IBS or obstruction they will heal with conservative management
Watch out for malabsorption
What should be avoided when managing perianal fistulae?
surgeons should avoid probing the fistula where acute inflammation is present
