Anorectal abscess: Difference between revisions
(Text replacement - " US " to " ultrasound ") |
Ostermayer (talk | contribs) (Text replacement - "abscess " to "abscess ") |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Usually begin via blocked anal gland (leads to infection/abscess formation) | *Usually begin via blocked anal gland (leads to infection/[[abscess]] formation) | ||
**Can progress to involve any of the potential spaces. | **Can progress to involve any of the potential spaces. | ||
===Perianal=== | ===Perianal=== | ||
| Line 33: | Line 33: | ||
*All perirectal abscesses should be drained in the OR | *All perirectal abscesses should be drained in the OR | ||
*Common bacteria: [[Staphylococcus aureus]], [[Escherichia coli]], [[Streptococcus]], Proteus and [[Bacteroides]] | *Common bacteria: [[Staphylococcus aureus]], [[Escherichia coli]], [[Streptococcus]], Proteus and [[Bacteroides]] | ||
*Isolated perianal abscess is only type of anorectal abscess that should be treated in ED | *Isolated perianal [[abscess]] is only type of anorectal [[abscess]] that should be treated in ED | ||
**Consider either linear incision with packing or cruciate incision with out packing | **Consider either linear incision with packing or cruciate incision with out packing | ||
**Frequent sitz baths | **Frequent sitz baths | ||
| Line 39: | Line 39: | ||
Causative organisms: Mixed infection with fecal flora for anaerobes and Gram Negatives ([[Bacteroides fragilis]] and [[Escherichia coli]]) | Causative organisms: Mixed infection with fecal flora for anaerobes and Gram Negatives ([[Bacteroides fragilis]] and [[Escherichia coli]]) | ||
'''Only indicated for:'''<ref>BMJ Best Practice Anorectal abscess http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal abscess and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref> | '''Only indicated for:'''<ref>BMJ Best Practice Anorectal [[abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref> | ||
*Elderly | *Elderly | ||
*Systemic signs (fever, leukocytosis) | *Systemic signs (fever, leukocytosis) | ||
Revision as of 13:20, 10 March 2017
Background
- Usually begin via blocked anal gland (leads to infection/abscess formation)
- Can progress to involve any of the potential spaces.
Perianal
- Most common
- Located close to anal verge, posterior midline, superficial tender mass
Ischiorectal
- 2nd most common
- Larger, indurated, well-circumscribed, located laterally on medial aspect of buttocks
Intersphincteric, deep postanal, pelvirectal
- Rectal pain, skin signs may not be present
- Constitutional symptoms often present
Risk Factors
- Crohn’s disease
- Chronic constipation
- Diabetes mellitus
- Chronic corticosteroid use
Clinical Features
- Worsening pain around bowel movement, with decreased pain post rectal evacuation
- Perirectal abscesses often accompanied by fever, leukocytosis
- May only be paplpated via digital rectal exam
- Tender inguinal adenopathy may be only clue to deeper abscesses
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Coccydynia
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Fecal impaction
- Hemorrhoids
- Levator ani syndrome
- Pedunculated polyp
- Pilonidal cyst
- Proctalgia fugax
- Proctitis
- Pruritus ani
- Enterobius (pinworms)
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Non-GI Look-a-Likes
Evaluation
- CT or ultrasound can be useful to define deep abscesses (esp with pain out of proportion to exam)
Management
- All perirectal abscesses should be drained in the OR
- Common bacteria: Staphylococcus aureus, Escherichia coli, Streptococcus, Proteus and Bacteroides
- Isolated perianal abscess is only type of anorectal abscess that should be treated in ED
- Consider either linear incision with packing or cruciate incision with out packing
- Frequent sitz baths
Antibiotics
Causative organisms: Mixed infection with fecal flora for anaerobes and Gram Negatives (Bacteroides fragilis and Escherichia coli)
- Elderly
- Systemic signs (fever, leukocytosis)
- Valvular heart disease
- Cellulitis
- Immunosuppression
Treatment options:
- Ciprofloxacin 500mg PO bid and Metronidazole 500mg PO tid
See Also
External Links
References
- ↑ BMJ Best Practice Anorectal abscess http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html
- ↑ Guidelines.gov - Practice parameters for the management of perianal abscess and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077