Anorectal abscess: Difference between revisions
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**Consider either linear incision w/ packing or cruciate incision w/o packing | **Consider either linear incision w/ packing or cruciate incision w/o packing | ||
**Frequent sitz baths | **Frequent sitz baths | ||
===Antibiotics=== | |||
Causative organisms: Mixed infection with fecal flora for anaerobes and Gram Negatives ([[Bacteroides fragilis]]and [[Escherichia coli]]) | |||
'''Only indicated for:''' | |||
*Elderly | |||
*Systemic signs (fever, leukocytosis) | |||
*Valvular heart disease | |||
* | *Cellulitis | ||
*Immunosuppression | |||
Treatment options: | |||
*[[Ciprofloxacin]] 500 mg PO bid and [[Metronidazole]] 500 mg PO tid | |||
==See Also== | ==See Also== | ||
Revision as of 14:37, 9 February 2015
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
- Perianal
- Can progress to involve any of the potential spaces:
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
Diagnosis
- CT or US can be useful to define deep abscesses (esp w/ pain out of proportion to exam)
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
Treatment
- 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 w/ packing or cruciate incision w/o packing
- Frequent sitz baths
Antibiotics
Causative organisms: Mixed infection with fecal flora for anaerobes and Gram Negatives (Bacteroides fragilisand Escherichia coli)
Only indicated for:
- Elderly
- Systemic signs (fever, leukocytosis)
- Valvular heart disease
- Cellulitis
- Immunosuppression
Treatment options:
- Ciprofloxacin 500 mg PO bid and Metronidazole 500 mg PO tid
See Also
Source
Tintinalli