II. Epidemiology

  1. Uncommon (represents only 5% of Anorectal Abscesses)

III. Pathophysiology

  1. Infection begins at the perianal crypts along the Dentate Line and spreads via the intersphincteric groove
  2. Infection may also spread from an intraabdominal source (e.g. perforated colon)
  3. Perirectal Abscess spread to above levator ani Muscle

V. Symptoms

  1. Rectal Pain (esp. with stooling)
  2. Urinary tract symptoms
  3. Urinary Retention
  4. Back Pain (referred pain from sacral nerve inflammation or compression)

VI. Signs

  1. Fever
  2. Tender, fluctuant mass may be present above the anorectal ring on Digital Rectal Exam
  3. External exam is typically unremarkable

VII. Differential Diagnosis

VIII. Imaging

  1. CT Pelvis

X. Diagnosis: Rectal mucosa fullness on diagnostic testing

XI. Management

  1. See Perirectal Abscess
  2. Colorectal surgery or General Surgery Consultation
    1. Ischiorectal Abscess extending into the Supralevator Space
      1. Drain as with Ischiorectal Abscess via skin access
    2. Intersphincteric Abscess extending into the Supralevator Space
      1. Internal sphincterotomy through incision in the anal mucosa (as with Intersphincteric Abscess)

XII. References

  1. Marx (2002) Rosen's Emergency Medicine, p. 1952
  2. Roberts (1998) Procedures, Saunders, p. 649-51
  3. Sherman, Bahga and Vietvuong (2022) Crit Dec Emerg Med 36(7): 23-9

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