Gastroenterology Book

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Perirectal Abscess

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  1. See Also
    1. Fistula-in-ano
  2. Epidemiology
    1. More common in men
  3. Pathophysiology
    1. Infection of anal glands
      1. Occurs at mucocutaneous junction (Dentate Line)
    2. Contiguous spread of infection in to ischiorectal space
    3. Causative organisms: Mixed infection with fecal flora
      1. Bacteroides fragilis (most common in adults)
      2. Escherichia coli (most common in children)
  4. Types
    1. Perianal Abscess (60%)
      1. Local Perianal Abscess
      2. Immediately adjacent to anal verge
    2. Ischiorectal Abscess (25%)
      1. Inferior to levator ani
      2. Two to 3 cm from anal verge
    3. Pelvirectal Abscess
      1. Superior to levator ani
      2. Pelvic or intraabdominal source
    4. Intersphincteric Abscess
  5. Predisposing Factors
    1. Crohn's Disease
    2. Diabetes Mellitus
    3. Immunodeficiency
    4. Pregnancy
  6. Symptoms
    1. Constant, throbbing perianal pain
  7. Signs: General
    1. Palpable, tender mass in perianal area or in rectum
    2. Drainage may be seen via perianal skin tract
      1. See Fistula-in-ano
  8. Management
    1. Surgical drainage is critical
      1. See types above for specific approach
    2. General Measures
      1. Stool Softeners (e.g. Colace)
      2. Sitz baths
      3. Frequent dressing changes
    3. Antibiotics usually not indicated
      1. Special Indications
        1. Systemic signs of infection
        2. Valvular heart disease
        3. Immunocompromised patient
      2. Antibiotic coverage (Anaerobes, Gram Negatives)
        1. Ciprofloxacin 500 mg PO bid and
        2. Metronidazole 500 mg PO tid
  9. References
    1. Goroll (2000) Primary Care Medicine, Lippincott, p. 426
    2. Marx (2002) Rosen's Emergency Medicine, p. 1951
    3. Roberts (1998) Procedures, Saunders, p. 649-51
    4. Surrell in Pfenninger (1994) Procedures, Mosby, p. 969

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