Perianal abscess, fistulae & fissure

• What are anal fissures?

  Linear tears/cracks in the distal anal canal

  Often causes severe pain & bleeding during or after bowel movements
• What are the RFs for anal fissures?

  Constipation

  Pregnancy

  IBD

  Anal cancer
• What are the signs & symptoms of anal fissures?

  Severe anal pain or tearing sensation during defecation (lasts for hours after)

  Anal spasms

  Bright red PR bleeding

  Itchy anus

  Visible fissure (90% are posterior)

  Sentinel pile (skin tag) -> visible in chronic cases
• What is shown in the image?

  Anal fissure

  
• What are the DDx of anal fissure?

  Haemorrhoids

  Anal abscess or fistula

  Anal cancer

  IBD
• What are the Inx for anal fissure?

  Full Hx & examination

  (PR if tolerable by pt)
• What is the management of anal fissures?

  Treatment of constipation (laxatives & dietary fibre)

  Topical analgesia (lidocaine cream/jelly)

  Topical vasodilators

  If have signs & symptoms of IBD -> refer to gastroenterology
• What is a perianal abscess?

  Infection resulting in a collection of pus near the anus

  Caused by bacterial invasion into anal glands
• What are the RFs of perianal abscesses?

  Crohn's disease

  Anal fistulae
• What are the signs & symptoms of perianal abscess?

  Anal pain

  Fever

  Fatigue

  Erythema & swelling around anus

  Anorectal discharge (purulent or bloody)

  Anorectal mass
• What are the signs & symptoms of perianal fistulae?

  Chronic discharge

  Recurrent abscesses

  Faecal soiling

  Signs of sepsis (hypotension, tachycardia, altered mental status, fever)
• A perianal abscess can lead to the formation of a fistula (an abnormal connection between anal canal & the skin).
• What are the Inx for perianal abscesses & fistulae?

  Obs

  Full Hx & examination

  Bloods (FBC, CRP, cultures)

  MRI pelvis (gold standard for abscess)
• What are the DDx of perianal abscesses?

  Anal fissure

  Haemorrhoids

  Perianal Crohn's disease
• What is the management of perianal abscesses?

  Drainage under local anaesthetic

  Incision & drainage under general anaesthetic

  Abx (if underlying condition -> diabetes, immunosuppression)
• What are the possible complications of perianal abscesses?

  Fistula formation

  Sepsis

  Necrotising fasciitis

  Anorectal stricture

  Incontinence