CHAPTER THREE

METHODS AND METHODOLOGY

Study area and period

The study Was conduct in Sulub Specialized Hospital,. The study will included
patients operated from December 1 20 21–February 30, 2022.

Study design
The study was prospective observational study involving Factors associated perenial abscess
the study
Source populations

All patients’ undergone elective perenial abscess the study during study period, in the specified
hospital Operational definition Factors associated perenial abscess. the target population was prepare
to determine Factors associated perenial abscess during study period. And target population of the
Hospital was 100.

Sample Size

2.
The sample size will estimated 1+N/N*E(0.05)
2.
Therefore 1+100/100*(0.05)
Therefore a minimum of 80 participants was sample.
3.5. Data Collection

The data was gathering by four personnel who have knowledge about the Factors associated perenial
abscess and know how to follow the patient. The data collector will training and oriented as to how
data collection proceed and the nature of questionnaire and the investigator was supervise each as
required during the data collection.
3.6. Sampling Technique
Factors associated perenial abscess Hospital center, IV was simply randomly selected and an
explanation about the study are given to them. Those who consented provided their demographics
and of which was recorded.
3.7. Data Analysis

After data collection, cleaning and checking of the content was, rates, ratio and percentage was
calculating using SPSS 20 software version.

Inclusion criteria:
patients who present with acute swelling in the perianal region in the age group more than 10 yrs
with pus being let out on incision and drainage.
Exclusion criteria:
1)patients under the age group of 10 yrs
2)Recurrent perianal abscess
3)patients with other types of anorectal abscess

3.8. Ethical Consideration

Data collection will start after permission has been obtained from SUL;UB Hospital , the
objective of the study was thoroughly explained and confidentiality was secure.

3.9. Limitation

Limited accessibility of internet.

There are no available (published) studies with similar context in Somalia settingrecently.
 CHAPTER FOUR

DATA ANALYZING AND INTERPRETATION

Gender of the respondents

The below table indicates the most of the respondents were the 54(57.5%) were the Male, while the
other respondents as well as indicates the 26(32.55) were the Female. So that the majority of the
respondents for this study of the research were male compared to the female

Table 1. Gender
Valid Frequenc Percent Valid Percent Cumulative Percent
y
Male 54 67.5 67.5 67.5
Female 26 32.5 32.5 100.0
Total 80 100.0 100.0

4.2. The major Investigation for the following procedure

The below table indicates the major of the investigation for the procedure so that the most of the
respondents indicates the 16(20%) were Blood sugar, while the 15(18.8%) were the Serum
creatinine, on the other hand of the respondents shows the 13 (16.3%) were the Blood urea more
over the other respondents indicates also 12(15%) were Serum creatinine, also other respondents
indicates the 10(12.5%) were Urine routine, lastly other respondents shows the 8(10%) were ECG
all leads o. the research indicates the major indicates the classifications.
Valid Frequenc Percent Valid Cumulative Percent
y Percent
Complete hemogram 6 7.5 7.5 7.5
Urine routine 10 12.5 12.5 20.0
Blood sugar 16 20.0 20.0 40.0
Blood urea o 13 16.3 16.3 56.3
Serum creatinine 12 15.0 15.0 71.3
USGabdomen &
15 18.8 18.8 90.0
pelvis o
ECG all leads o 8 10.0 10.0 100.0
Total 80 100.0 100.0
Table 2. What is the major Investigation for the following procedure
4.3. The techniques you use for the Vitals perennial abscess.
The below table indicates the major of the respondents 37(46.3%) were Blood pressure, while the
24(30%) were the pulse rate, on the other 19(23.8%) were temperature. So that the research
indicates the major classification techniques used fo the Vital perennial abscess.
Table 4. What techniques you use for the Vitals
Frequenc Percent Valid Cumulative Percent
y Percent
Pulse rate: 24 30.0 30.0 30.0
Blood
37 46.3 46.3 76.3
Valid pressure
Temperature 19 23.8 23.8 100.0
Total 80 100.0 100.0

5. What are the Past history you present at abscess.

The below table indicates the the majority of the respondents were the 31(38.8%) H/O Diabetes/
Hypertension/Dyslipidemia/ CAD/ CKD/BA, while the other respondents indicates also 28(25%)
were tuberculosis H/Moreover the other respondents indicates the 21(26.3%) were the chronic
drug intake.

Table 5. what are the Past history you present at abscess

Frequenc Perce Valid Percent Cumulative Percent
y nt
H/O Diabetes/
Hypertension/
31 38.8 38.8 38.8
Dyslipidemia/ CAD/
CKD/BA H/O
tuberculosis H/O 28 35.0 35.0 73.8
chronic drug intake. 21 26.3 26.3 100.0
Total 80 100.0 100.0

6. what is the H/O Presenting illness.

 Frequenc Percent Valid Cumulative Percent
y Percent
H/O fever 10 12.5 12.5 12.5
H/O trauma 22 27.5 27.5 40.0
H/O altered bowel
Valid 31 38.8 38.8 78.8
habits
H/O skin lesions 17 21.3 21.3 100.0
Total 80 100.0 100.0
The below table indicates the majority of the respondents 31(38.8%) were H/O altered bowel habits,
while the respondents indicates the 22(27.5%) were the H/O trauma, on the hand there on another
respondents indicates the 17(21.3%) were the H/O skin lesions, lastly other respondents indicates the
10(12.5%) were H/O fever.
Table 5. what is the H/O Presenting illness
7. what are the most of the Chief complaints
The below table indicates the majority of the respondents 52(65.0%) were the C/O pain in the
perianal region, moreover the other respondents shows the 28(35%) were the C/O swelling in the
perianal region, so that the research indicates the most of the complaints of the perennial abscess
were C/O pain in the perianal region compared to the C/O swelling in the perianal region. Table
6. what are the most of the Chief complaints
Frequen Percent Valid Cumulative Percent
Valid cy Percent
C/O pain in the perianal region 52 65.0 65.0 65.0
C/O swelling in the perianal
28 35.0 35.0 100.0
region
Total 80 100.0 100.0

8. the major symptoms distribution of the perennial abscess.

The below table indicates the majority of the respondents 33(41.3%) were discharge, while the
other respondent indicates the 17(21.3%) were the fever, on the other hand the respondents
shows also 16(20%) were pain, moreover the 14(17.5%) were swelling. the research indicates
that the major of the symptoms of the perennial abscess. And its categories percentage
distribution.

Table 7. what the major symptoms distribution

Valid Frequen Percent Valid Percent Cumulative Percent
cy
discharge 33 41.3 41.3 41.3
fever 17 21.3 21.3 62.5
swelling 14 17.5 17.5 80.0
pain 16 20.0 20.0 100.0
Total 80 100.0 100.0
9. what are major causes extrasphincteric perennial abcess in ano
the below table indicates that the majority of the respondents 24(30%) were Penetrating injury to
the perineum, while the other respondents shows the 20(25%) were the carcinoma of rectum, on
the other hand the research respondents also indicates the 18(22.5%) were the Crohn’s disease,
moreover the other respondent list also indicates the 11(13.8%) were the pelvic inflammatory
disease, finally other respondents also indicates the respondents of the research 7(8.8.%) were the
Foreign body penetration of the rectum via drainage through the levator ani muscle what are major
causes extrasphincteric perennial abcess in ano
Frequ Percent Valid Cumulative Percent
Valid ency Percent
Foreign body penetration of the
rectum via drainage through the 7 8.8 8.8 8.8
levator ani muscle
Penetrating injury to the perineum 24 30.0 30.0 38.8
Crohn’s disease 18 22.5 22.5 61.3
carcinoma of rectum 20 25.0 25.0 86.3
pelvic inflammatory disease 11 13.8 13.8 100.0
Total 80 100.0 100.0
 CHAPTER FIVE
DISCUSSION, CONCLUSION, RECOMMENDATION

5.1. Discussion
In this study 80 patients with perianal abscesses were studied. Of the 80 patients 54 patients were
male and and 26 patients were female. So that it indicates the most of the respondents were the
54(57.5%) were the Male, while the other respondents as well as indicates the 26(32.55) were the
Female. So that the majority of the respondents for this study of the research were male compared
to the female.
As per Mehmet Ulug et al {11} who did a study on “The evaluation of bacteriology in perianal
abscesses of 81 adult patients” 86% were male patients and 14% were female patients and the
mean age of patients was 40.5+11.3 yrs in males and 35.8+13 yrs in females. In this study 63%
were males and 37% were females and the mean age of male and female patients was 42.3+11.8
yrs (range 21-80) and 37.6+7.4 yrs (range 19-50) respectively.
indicates the majority of the respondents 33(41.3%) were discharge, while the other respondent it
indicates the 17(21.3%) were the fever, on the other hand the respondents shows also 16(20%)
were pain, moreover the 14(17.5%) were swelling. the research indicates that the major of the
symptoms of the perennial abscess. And its categories percentage distribution.
It indicates that the majority of the respondents 24(30%) were Penetrating injury to the perineum,
while the other respondents shows the 20(25%) were the carcinoma of rectum, on the other hand
the research respondents also indicates the 18(22.5%) were the Crohn’s disease, moreover the
other respondent list also indicates the 11(13.8%) were the pelvic inflammatory disease, finally
other respondents also indicates the respondents of the research 7(8.8.%) were the Foreign body
penetration of the rectum via drainage through the levator ani muscle.
Majority of patients had abscess located in the posterior aspect (53%) of anal canal as per
Ramanujam et al, followed by lateral (35%) and anterior (12%) positions. In a review by
Vasilevsky and Gordon {13} on “The incidence of recurrent abscesses or fistula-in-ano following
anorectal suppuration” laterally placed abscesses were recorded with much higher incidence and
four posteriorly located horse shoe abscesses were present. In this study majority of patients had
abscesses in the lateral location with 34% of abscesses in the right lateral side and 31% of
abscesses in the left lateral side, followed by 29% of abscesses in the posterior location and the
least (6%) in the anterior relation of anal canal. Smoking and alcoholism was noted in 15 patients.
Twelwe patients were alcoholics and five were smokers. Both alcoholism and smoking was noted
in 2 patient. Incision and drainage of abscess was done in all patients and antimicrobial therapy
was given to all.
For this study It indicates the majority of the respondents 52(65.0%) were the C/O pain in the
perianal region, moreover the other respondents shows the 28(35%) were the C/O swelling in the
perianal region, so that the research indicates the most of the complaints of the perennial abscess
were C/O pain in the perianal region compared to the C/O swelling in the perianal region. indicates
the majority of the respondents 31(38.8%) were H/O altered bowel habits, while the respondents
indicates the 22(27.5%) were the H/O trauma, on the hand there on another respondents indicates
the 17(21.3%) were the H/O skin lesions, lastly other respondents indicates the 10(12.5%) were
H/O fever.
For this study indicates the the majority of the respondents were the 31(38.8%) H/O Diabetes/
Hypertension/Dyslipidemia/ CAD/ CKD/BA, while the other respondents indicates also 28(25%)
were tuberculosis H/Moreover the other respondents indicates the 21(26.3%) were the chronic
drug intake.
5.2. Conclusion
Perianal abscesses are very common. They are more common in men than in women
Significant number of patients who underwent treatment for perianal abscess would develop
persistent aggravating symptoms. An anal fistula indicates a chronic phase of an unhealed abscess.
Because of this after drainage of perianal abscesses it is advised to do careful examination under
anaesthesia seven to ten days later when the results of culture and sensitivity are available to look
for an underlying fistula.
Incision and drainage is the foremost handling for perianal abscess. This is important because the
abscess environment (low PH, capsule of the abscess, and the presence of binding proteins ) is
unfavorable to the efficiency of antibiotics. Although antibiotics may prevent suppuration if given
early or may prevent spreading of an abscess, they cannot be relieved for drainage of abscess.
The prevalence of perianal abscess among patients with type 2 diabetes was higher than that seen
in type 1 diabetes when comparing patients within specific age groups. This suggests that factors
other than autoimmune disease predispose to this condition and that metabolic factors play an
important role. Poor glycemic control clearly predisposed to the development of perianal abscess.
High BMI may also be a risk factor for perianal abscess, and this association was the subject of
future studies by this group.
It is important to design specific clinical pathways adapted to the needs and microbiological
characteristics of each region, to optimize the management of patients with anorectal abscesses
with or without anal fistula. With regard to anal fistulas, simple abscess drainage can be curative in
more than half of the cases. Consultation to the specialized COD is recommended in cases of
recurrent anal abscesses, anal fistulas, and immunosuppressed patients, given its increased risk of
chronic anal fistula. We can conclude that the optimal management of anal abscess in ED is still a
pending task. A proper diagnosis and treatment both in the ED and in specialized outpatient
consultation, will reduce antibiotic resistance, preventing annoying, unnecessary and expensive
proceedings to the patient, as well as avoid additional costs for the National Health System.
5.3. Recommendation
Perirectal abscesses often require surgical drainage even if they have ruptured or are already
training. Therefore a general or colorectal surgeon should be consulted to evaluate the patient.
Alternatively, an ED physician may perform the drainage procedure themselves.
Perirectal abscess affects many people in between the third and fourth decade of life. These
abscesses are extremely difficult to treat and errors in management can lead to fistula formation.
Many patients have repeated visits to the emergency room for urinary retention, pain, fecal
incontinence, and chronic constipation- all of which lead to a rise in healthcare costs. Thus, these
lesions are best managed by an inter professional team that includes the following:-
 The emergency department physician to manage the acute pain, urinary retention, and
bacteremia
 The colorectal surgeon who performs the fistulotomy or Seton placement
 Dietitian to educate the patient on a high fiber diet to relieve constipation
 Infectious disease nurse to educate and monitor the patient on the maintenance of personal
hygiene, safe sex practice and remain compliant with antibiotics.
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 APPENDIX 1 : QUESTIONNAIRE
Dear respondent

my names of; Dr.Faysal carrying out a study on ” Risk factors associated perennial Abscess
among adult’s patients in madina hosptal”. We are very glad that you are my respondent for
this study. The purpose of this questionnaire was to obtain your opinion/views to be included
among others in the study. This research is one of the requirements leading to the award of Mater
Degree It is hence an academic research and will not be used for any other purpose other than
academic. Your co-operation and answers to these questions heartily and honestly was
significant to this study to gather the data needed.

Section One: Demographic characteristics

1. Gender
1. Male
2. Female
2. Age of respondents
1. 18-28 years
2. 29-39 years
3. 40-49 years
4. 51 and above years
SECTION TWO.
1. What is the major Investigation for the following procedure

 Complete hemogram

 Urine routine
 Blood sugar
 Blood urea o
 Serum creatinine
 USG abdomen & pelvis o
 ECG all leads o
 Chest Xray PA view
2. What tecniques you use for the Vitals

a.Pulse rate:

48
b.Blood pressure:

Temperature:

3. what are the Past history you present :

a. H/O Diabetes/ Hypertension/ Dyslipidemia/ CAD/ CKD/BA H/O

b. tuberculosis H/O

c. chronic drug intake.

4. what is the H/O Presenting illness

a. H/O fever

b. H/O trauma

c.

c. H/O altered bowel habits

d. H/O skin lesions

5.what are the most of the Chief complaints:

a) C/O pain in the perianal region

b) C/O swelling in the perianal region

6. what the major symptoms distribution

a. discharge

b. fever

c. swelling

d. pain

7. what are major causes extrasphincteric perennial abcess in ano

1) Foreign body penetration of the rectum via drainage through the levator ani muscle

2) Penetrating injury to the perineum

3) Crohn’s disease

4) carcinoma of rectum

5) pelvic inflammatory disease