The Anorectal Abscess

Perianal abscess
Definition -
• Infection of the soft tissue surrounding the anal canal, with formation
of discrete abscess cavity.
• Often cavity is associated with fistulous tract.
Pathophysiology
• Infection starts in crypto glandular epithelium lining the anal canal.
• Internal anal sphincter a barrier to infection passing from gut to deep
perirectal tissue.
• Duct of Anal gland penetrate internal sphincter into intersphincteric
space.
• Once infection sets in intersphincteric space it can spread further.
Etiology
• Abscess initially forms in the intersphincteric space and spreads along
adjacent potential spaces.
• Common organisms-
* E.Coli
* Enterococcus species
* Bacteroides species.
Etiology
Less common causes -
• Crohn’s Disease.
• Cancer.
• Tuberculosis.
• Trauma.
• Leukemia.
• Lymphoma.
Clinical features
Symptoms- Signs-
• Pain Perianal movement ↑ • Swelling
pressure ↑ • Cellulitis
• Pruritis • induration
• Generally unwell. • Fluctuation
• Fever • Subcutaneous mass, near
• Chill and rigor. Perianal orifice.
• DRE- fluctuation at times in
ischorectal.
Classification
• Perianal – pus underneath skin of anal canal, do not traverse external
sphincter.
• Ischiorectal – suppuration traversing external sphincter into
Ischiorectal space.
• Intersphincteric – suppuration between external and internal
sphincter.
• Horse shoe abscess - uncommon circumferential infiltration of pus
with in intersphincteric space.
Investigation & Imaging
• No specific test required
• Patients with diabetes , immunosuppresed will need lab evaluation.
• Imaging – role in only deep seated, Supralevator or intersphincteric
abscesses.
CT Scan , MRI or Anal ultrasonography.
Management
• Mainly surgical
• Antibiotics in diabetics & immunocompromised individuals.
• Early drainage is indicated as delay can cause-
* prolong infection
* tissue destruction ↑
* chances of sphincter dysfunction ↑
* Promote fistula formation.