perianal fistula + abscess

Question 1

what is an anorectal abscess?

Answer 1

An anorectal abscess is a localized collection of pus in the perianal or rectal spaces, commonly arising from an infection in the anal glands.

Question 2

who are anorectal abscesses seen in?

Answer 2

males
20-40 years old

Question 3

RF for anorectal abscesses?

Answer 3

Anal fistulae: These are abnormal connections between the surface of the anal canal and the exterior skin.
Crohn’s disease: This chronic inflammatory bowel disease can lead to the formation of abscesses due to constant irritation and inflammation of the bowel wall.

Question 4

features of anorectal abscesses?

Answer 4

Perianal pain: Often severe and aggravated by sitting or bowel movements.
Perianal swelling: This may be fluctuant and tender upon examination.
Systemic symptoms: Low-grade pyrexia, tachycardia, and potentially sepsis if the infection spreads, leading to haemodynamic compromise.

Question 5

ix for anorectal abscess?

Answer 5

Inspection is performed to detect perianal swelling, and a digital rectal examination (if tolerated) is conducted to assess the size of the swelling.

Assessment of vital signs
Full blood count, CRP, and ESR can aid in detecting systemic inflammation and infection. Blood cultures may be necessary if sepsis is suspected.

MRI pelvis is the gold standard for definitive diagnosis of an anorectal abscess. If unavailable ultrasound may be of benefit.

Question 6

mx of anorectal abscess?

Answer 6

Drainage: Perianal abscesses can be drained in A&E under local anaesthesia.
Incision and drainage under general anaesthetic: This is necessary when the degree of tissue damage is unknown or in the case of deep perirectal abscesses with sphincter extension.
Antibiotics are used if there is an underlying condition such as diabetes or immunosuppression. If on presentation the patient is already septic, intravenous antibiotics will be needed.