Anorectal abscess: Difference between revisions
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*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=== | ||
*Most common | *Most common | ||
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*Constitutional symptoms often present | *Constitutional symptoms often present | ||
==Risk Factors== | ===Risk Factors=== | ||
*Crohn’s disease | *Crohn’s disease | ||
*Chronic constipation | *Chronic constipation | ||
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==Evaluation== | ==Evaluation== | ||
*CT | *CT with IV contrast can be useful to define deep abscesses (especially with pain out of proportion to exam) | ||
*MRI | *May consider [[ultrasound]] or MRI as alternatives | ||
==Management== | ==Management== | ||
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**Consider either linear incision with packing, elliptical incision, or cruciate incision with out packing | **Consider either linear incision with packing, elliptical incision, or cruciate incision with out packing | ||
**Frequent sitz baths | **Frequent sitz baths | ||
===Antibiotics=== | ===Antibiotics=== | ||
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]]) | ||
Revision as of 20:58, 19 April 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
- High incidence of fistula formation even with drainage
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 with IV contrast can be useful to define deep abscesses (especially with pain out of proportion to exam)
- May consider ultrasound or MRI as alternatives
Management
- All perirectal abscesses should be drained in the OR
- All anorectal abscess requires surgical referral and followup
- 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, elliptical incision, 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