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Chapter: Medicine and surgery: Gastrointestinal system

Anorectal abscess - Disorders of the rectum and anus

Anorectal abscesses may occur as perianal, ischiorectal or high muscular abscess. - Definition, Incidence, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

Anorectal abscess

 

Definition

 

Anorectal abscesses may occur as perianal, ischiorectal or high muscular abscess.

Age

 

Most common 20–40 years.

 

Sex

 

2M : 1F

 

Aetiology

 

In the majority of patients there is no apparent cause for abscess formation. Recurrent abscesses occur in inflammatory bowel disease, HIV and rectal carcinoma.

 

Pathophysiology

 

Infection of an anal gland may cause a tracking down to form a perianal abscess, or tracking out to form a ischiorectal abscess, or upwards to produce a high inter-muscular abscess.

 

Clinical features

 

Perianal abscess is common and presents in well patients with an acute tender swelling at the anal verge.

 

Ischiorectal abscess present with a diffuse hard painful swelling lateral to the anus, which may extend behind the anal canal to form a horseshoe abscess. Patients have significant systemic upset.

 

High intermuscular abscesses cause pain exacerbated on defecation, a boggy tender swelling is felt on rectal examination.

 

Management

 

Perianal and ischiorectal abscesses are drained under general anaesthetic and de-roofed by making a cruciate incision and excising the resultant 4 triangles of skin. 25% of abscesses recur.

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Medicine and surgery: Gastrointestinal system : Anorectal abscess - Disorders of the rectum and anus |


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