Anorectal abscess
Dr. Santosh S. Pathak
M.S. ( shalya )
Abscess
DEFINATION --- A perianal abscess is a
collection of pus in one of the anatomic
spaces of the anal region.
► Theperianal anatomy is defined by the
sphincter and the levator ani muscles
► TheIliococcygeus, Pubococcygeus, and
Puborectalis
Abscesses
Abscesses can be classified according to
location
►Perianal, Supralevator, Intersphincteric
►The most common location is perianal
►It results from a blockage of the anal
glands located just outside the anus
ANORECTAL ABSCESS
► Analglands lie in intersphincteric space
between internal and external sphincter.
► Itsinfection leads to formation of local
abscess in intersphincteric plane.
ANAL CANAL
►There are about 4-8
anal glands normally.
►These glands are
usually confined to
the submucosa but
some of the branches
may cross the
sphincter to reach the
intersphincteric
longitudinal layer.
PATHOLOGY
Infection of anal Intersphicteric Mode of spread
glands abscess of the abscess
Formation of Different
fistula in ano varieties of
fistula in
ano
Abscess pathology
► According to the crypto-glandular theory, they
often develop from cryptitis which may be
associated with an enlarged papillae in the anal
canal.
► Itstarts as a cellulitis with only swelling and
erythema.
► Finally,
the infecting organisms burrow in the anal
glands producing the abscess.
Abscess
► As the abscess enlarges it escapes the
confines and spreads in possible directions to
form a perianal abscess(being most common)
or ischiorectal abscess.
► More than 95% are caused by infections
([Link], staph aureus) arising in anal glands
that communicate with the anal crypts.
ACUTE STAGE OF INFECTION CAUSES
ANORECTAL ABSCESS
WHILE CHRONIC STAGE CAUSE ANAL
FISTULA.
Abscess
► The microorganisms are not specific or
unique
► They are usually polymicrobial
► More than 90% will include E. coli
► Other organisms include streptococci,
staphylococci, and a variety of anaerobic
bacteria
CLASSIFICATION:
► There are four main varieties
1. PERIANAL ABSCESS
2. ISCHIORECTAL ABSCESS
3. SUBMUCOUS ABSCESS
4. PELVIRECTAL ABSCESS
PERIANAL ABSCESS
Suppuration in the anal gland spreads to lie in
region of subcutaneous portion of external
sphincter.
If not evacuated it becomes infected and abscess
results.
It can occur at any age.
Abscess -- Symptoms
► The patient will present with fever, local
inflammation, and pain
► The initial manifestation is fever followed by
pain
► In 24-48 hours a fluctuant mass will appear
► An abscess in the intramuscular space may
be difficult to diagnose and treat
► Clinical assumption is needed to treat
appropriately
Abscess
Spaces of anorectal region
ISCHIORECTAL ABSCESS
► It is an extension of a low intermuscular anal
abscess through the external sphincter. Fat in the
fossa being poorly vascularised is more vulnerable.
► This abscess rarely presents as a visible bulge as
in case of perianal abscess due to large potential
space of ischiorectal fossa. Via the post sphincteric
space it communicates with the fossa on opposite
side. ( horseshoe fistula )
Ischiorectal Fossa
► SUBMUCOUS ABSCESS: Less common.
Occurs above the dentate line.
► PELVIRECTAL ABSCESS: Situated between
the upper surface of the levator ani and
pelvic peritoneum. It is more or less a
pelvic abscess and is usually secondary to
appendicitis, salphingitis etc.
Abscesses -- treatment
► Treatment consists of surgically draining the
infected cavity
► A cruciate incision is made to allow pus to
drain for a few days
► Sometimes a drain is left in the incision to
assure adequate drainage.
► A fistulous tract can arise if the abscess is
not treated properly.
Abscess should be drained immediately
before erythema or fluctuance develops.
Antibiotics are not indicated
ISCHIO-RECTAL ABSCESS WITH
SCROTAL INVASION
SCROTAL - INFLAMMATION
INCISION ON THE SCROTUM
CRUCIATE INCISION
TRIMMING THE EDGES OF CRUCIATE
INCISION
DURING TRIMMING PROCESS
CHANGES AFTER ONE WEEK
