Perineal Abscesses And Fistulae

Question 1

Define Perineal Abscess?

Answer 1

A pus collection in the perineal region

Question 2

Define Perineal Fistula?

Answer 2

An abnormal chronically infected tract communicating between the perineal skin and either the anal canal or the rectum

Question 3

What is the aetiology of anal abscesses and fistulae?

Answer 3

Bacterial Infection
Fistulae develop as a complication of an abscess
Fistulae can develop as a complications of Crohn’s Disease

Question 4

What is Pepper Pot Perineum?

Answer 4

The development of multiple perineal fistulae in Crohn’s Disease

Question 5

What are the risk factors for anal abscesses and fistulae

Answer 5

IBD
DM
Malignancy

Question 6

What is the epidemiology of anal abscesses and fistulae?

Answer 6

COMMON

Question 7

What are the presenting symptoms of anal abscesses and fistulae?

Answer 7

Constant throbbing pain in the perineum
Intermittent discharge (Mucus or faecal staining) near the anal region
Personal or family history of IBD

Question 8

What are the signs of anal abscesses and fistulae on physical examination?

Answer 8

Localised tender perineal mass (may be fluctuant)

Small skin lesion near the anus (opening of the fistula)

Question 9

What is DRE for anal abscesses and fistulae?

Answer 9

A thickened area over the abscess/fistula may be felt

DREs are not always possible due to pain and anal sphincter spasm

Question 10

What is Goodsall’s Law?

Answer 10

This is a rule that allows you to correlate the location of the internal fistula opening based on the location of the external fistula opening
If the external fistula opening is ANTERIOR to the anal canal, the fistula runs radially and directly into the anal canal
A fistula that is 3 cm away and any fistula that has an external fistula opening lying posterior to the transverse anal line will follow a curved path and open internall in the posterior midline

Question 11

What bloods do you do for perianal abscesses and fistulae?

Answer 11

FBC
CRP
ESR
Blood Culture

Question 12

What Imaging do we do for perianal abscesses and fistulae?

Answer 12

MRI

Question 13

What is the other investigation we can do for perianal abscesses and fistulae?

Answer 13

Endoanal US

Less useful than MRI

Question 14

What is the management plan for perianal abscesses and fistulae?

Answer 14

Requires surgical treatment
Open drainage of abscess
Laying open of fistula
Antibiotics

Question 15

What is the laying open of fistula for perianal abscesses and fistulae?

Answer 15

A probe is inserted to explore the fistula

A dye can be inserted into the external opening to allow you to find the internal opening

Question 16

What happens if it is a Low Fistula?

Answer 16

Fistulotomy

Care must be taken to prevent damage to the anal sphincter

Question 17

What do you do for a High Fistula?

Answer 17

Fistulotomy would cause INCONTINENCE so is NOT performed

Seton - a non-absorbable suture that is threaded through the fistula and allows drainage

Question 18

What are the possible complications of perianal abscesses and fistulae?

Answer 18

Recurrence
Damage to internal anal sphincter
Incontinence
Persisting pain

Question 19

What is the prognosis for patients with perianal abscesses and fistulae?

Answer 19

High recurrence rate without complete excision