ano rectal abscess in Homoeopathic perspective

academic purpose alone it is useful

1. ANORECTAL ABSCESS Dr.A.S.SHIVASARAVANAN,M.D,Ph.D (HOM) PROFESSOR & HOD DEPARTMENT OF SURGERY VMHMC SALEM 3/12/2024 1

2. Epidemiology  Peak incidence: 3 rd and 4 th decades of life Men are affected more frequently than women are, with a male-to-female predominance of 2:1 to 3:1 3/12/2024 2

3. Anorectal abscess DR.A.S.SHIVASARAVANAN,M.D( hom ) ASSOCIATE PROFESSOR DEPARTMENT OF SURGERY, VMHMC,SALEM 3/12/2024 3

4. CLASSIFICATION Perianal (60%) Ischiorectal (30%): extension laterally through the external sphincter Submucous (5%) Pelvirectal : situated between the upper surface of the levator ani and the pelvic peritoneum 3/12/2024 4

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6. Clinical features Perianal discomfort/ pain- throbbing/ aching exacerbated by movement and increased perineal pressure from sitting or defecation Perianal swelling Perianal abscess usu. presents early(2-3 days) whereas ischiorectal abscess usu. presents later Ischiorectal abscess often presents with high grade fever with chills and rigor 3/12/2024 6

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9. On examination Perianal swelling: Tender, erythematous , fluctuant, warm DIGITAL RECTAL EXAMINATION : a fluctuant, indurated mass may be encountered Fluctuation may not be present in ischiorectal abscess (late feature) 3/12/2024 9

10. Investigations Clinical diagnosis Investigations relevant to specific causes When abscess is not obviously apparent but a high degree of clinical suspicion exists Ultrasound, CT scan and MRI may be helpful Pus culture 3/12/2024 10

11. Treatment Early surgical drainage of the purulent collection Primary antibiotic therapy alone is ineffective Any delay : augments tissue damage, may impair sphincter continence function, promote stricture and/or fistula formation 3/12/2024 11

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13. Post operative Analgesics Stool softners Antibiotics follow up: 2-3 weeks for wound evaluation and inspection for possible fistula-in- ano . 3/12/2024 13

14. Pelvirectal abscess: Diagnosis and treatment of underlying pelvic pathology Drainage of pus through the rectum or through posterior fornix in females 3/12/2024 14

15. Take home message Anorectal abscess usually produce throbbing pain, swelling in the anal region. Anatomically classified as perianal , ischiorectal , submucous and pelvirectal abscess. Primary modality of treatment is drainage of pus with analgesics and appropriate antibiotics Underlying problem should be looked for and adequately treated 3/12/2024 15

16. References Bailey & Love’s Short Practice of Surgery, 26 th Edition Manipal Manual of Surgery, K.R. Shenoy et al, 4 th Edition SRB’s Manual of Surgery, S. Bhat M, 4 th Edition Beard JM, Osborn J. Anorectal Abscess. Rakel RE, Rakel DP, Textbook of Family Medicine . 8th ed. Philadelphia, Pa: Saunders; 2011 3/12/2024 16

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