Abscess

• There are a number of risk factors associated with perianal abscesses.

  • Fistula-in-ano
  • Inflammatory bowel disease
  • Diabetes mellitus  
  • Immunosuppression
• Most patients are systemically well at presentation, but a significant minority may present with features of systemic infection or sepsis.

  • Perianal swelling
  • Perianal pain
  • Malaise
• Signs:

  • Fluctuant, tender perianal swelling
  • Pus discharge
  • Erythema
  • Fever
• Incision and drainage is the definitive management for a peri-anal abscess.

  Patients who are systemically unwell, have markedly raised inflammatory markers, are elderly or co-morbid should be admitted until definitive management. Consider commencing IV antibiotics.
• • Anorectal abscess refers to a collection of pus in the anal or rectal region
  • More common in men
  • High rate of recurrence
  • One third of patients have an associated perianal fistula
• Pathophysiology:

  • Plugging of the anal ducts - which drain the anal glands in the anal wall
  • Leads to fluid stasis which leads to infection
  • Anal glands are located between the internal and external anal sphincters, therefore infection from the glands here spreads to adjacent areas
• Patients with an anorectal abscess without any known fistula-in-ano or other rectal pathology should have their serum glucose or HbA1c sent to check for underlying diabetes mellitus.
• After examination and incision + drainage under general anaesthetic, the wound is left to heal by secondary intention
• Intra-operative proctoscopy should be performed to check for the presence of any identifiable fistula-in-ano.