Rectum

Ischiorectal Abscess

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Ischiorectal Abscess

  • Epidemiology
  1. Represents 25% of Perirectal Abscess
  • Pathophysiology
  1. Perirectal Abscess involving ischiorectal space
  2. Anatomic boundaries
    1. Lateral to external sphincter
    2. Below levator ani
  • Signs
  • Low Abscess
  1. See Perirectal Abscess
  2. Infection of fatty tissue below Rectum
  3. Perianal tenderness and swelling 2-3 cm from anal verge
  • Differential Diagnosis
  1. High Abscess
    1. Pelvirectal Abscess
    2. Intersphincteric Abscess
  2. Low Abscess
    1. Perianal Abscess (immediately adjacent to anal verge)
  1. Evaluation of complex or suspected high abscess
  • Management
  1. See Perirectal Abscess
  2. Local Incision and Drainage indications
    1. Low abscess without signs of higher spread
    2. Non-toxic appearance
  3. Surgical referral for drainage indications
    1. Signs of fasciitis and deep ischiorectal spread
  • Complications
  • Deep spread of infection
  1. Posterior rectal space infection (horseshoe abscess)
  2. High Ischiorectal Abscess
  • References
  1. Marx (2002) Rosen's Emergency Medicine, p. 1952
  2. Roberts (1998) Procedures, Saunders, p. 649-51