Perineal Abscess and Fistulae

Question 1

ESSENCE

Answer 1

Collection of pus or infected materal inside peritoneal cavity

Question 2

AETIOLOGY

Most common causes

Answer 2

• Depends where abscess is
• Intraperitoneal
  
  • Post-operative
  • Perforation
  • Appendicitis
  • Diverticulitis
• Retroperitoneal
  
  • Trauma
  • Pancreatitis
  • Spread of renal parenchymal abscess
• Visceral
  
  • Trauma
  • Ascending cholangitis
  • Haematogenous

Question 3

AETIOLOGY

Risk factors

Answer 3

• Diabetes
• Malignancy
• Recent surgery or trauma, appendicitis, diverticulitis or perforated ulcer

Question 4

CLINICAL FEATURES

Presentation

Answer 4

• Fever or hypothermia
• Abdominal pain
• Tachycardia
• Change in bowel habit
• Nausea and vomiting

Question 5

INVESTIGATION

First choice

Answer 5

• Abdominal CT scan
• WBC count

Question 6

MANAGEMENT

General principles

Answer 6

• Sourse control - CT or US guided drainage, or surgical drainage
• Empirical broad spectrum antibiotics
  
  • Choice depends on community or healthcare acquired and tghe severity/risk
• Switch to targeted antibiotics once cultures known