PERIANAL ABSCESS & ISCHIORECTAL ABSCESS

PERIANAL & ISCHIORECTAL ABSCESSES COME UNDER ANORECTAL ABSCESSES.IN THIS PPT DISCUSS THE DIFFERENCE BETWEEN PERIANAL & ISCHIORECTAL ABSCESS

1. PERIANAL ABSCESS & ISCHIORECTAL ABSCESS - Dr.Navya Teja

2. ANORECTAL ABSCESS MC organism – E.COLI Commonly occurs due to infection of anal glands in relation to crypts-CRYPTOGLANDULAR DISEASE (95%) Common in diabetics & immunocompromised Other causes- injury to anorectum Cutaneous infection ( boil) Blood born infections

3. PATHOPHYSIOLOGY Originates from an infection arising in the crypto glandular epithelium lining the anal canal The internal anal sphincter normally serves as a barrier to infection passing from the gut lumen to the deep perirectal tissues. This barrier can be breached through the crypts of Morgagni, which can penetrate through the internal sphincter into the intersphincteric space

4. PATHOPHYSIOLOGY Once infection gains access to the intersphincteric space, it has easy access to the adjacent perirectal spaces Extension of the infection can involve the intersphincteric space 2–5%, ischiorectal space 20-25% , or even the supralevator space 2.5%.

5. DIFFERENTIAL DIAGNOSIS FOR ANORECTAL ABSCESS PERIURETHRAL ABSCESS BARTHOLIN ABSCESS TUBERCULOUS ABSCESS

6. WORKUP/INVESTIGATIONS MRI – IOC PERINEAL & ANAL USG- also useful CBC may show leukocytosis Pus cultures Blood cultures

7. CLASSIFICATION OF ANORECTAL ABSCESS Perianal (60 %) Ischorectal ( 30 %) Submucous Pelvirectal Fissure abscess

8. Classification

9. PERIANAL ABSCESS

10. PERIANAL ABSCESS (60%) Lies in region of subcutaneous portion of EXTERNAL SPINCTER Usually results from suppuration of anal gland or thrombosed ext pile or any infected perianal condition

11. PERIANAL ABSCESS-CLINICAL FEATURES SEVERE PAIN in perianal region with difficulty to sit O/E- tender,smooth,soft ,swelling in the region

12. PERIANAL ABSCESS-TREATMENT I & D SITZBATH +ANTIBIOTICS+ANALGESICS +L/A of ANAESTHETIC AGENTS+LAXATIVES

13. ISCHIORECTAL ABSCESS ( 30%)

14. ISCHIORECTAL FOSSA PYRAMIDAL IN SHAPE 5CM DEPTH,2 CM WIDTH Right & left communicate with each other through posterior spincteric space- HORSE SHOE abscess

15. ISCHIORECTAL FOSSA- BOUNDARIES LATERALLY-f ascia covering OBTURATOR INTERNUS MEDIALLY- LEVATOR ANI & EXTERNAL SPINCTER POSTERIORLY- SACROTUBEROUS LIGAMENT & GLUTEUS MAXIMUS ANTERIORLY- UROGENITAL DIAPHRAGM BELOW- BY SKIN

16. ETIOLOGY Commonly it is due to extension of lower intermuscular anal abscess laterally through ext spincter Fat in fossa is more prone to infection coz its LEAST VASCULARISED

17. CLINICAL FEATURES Tender,indurated,brawny swelling in the skin over ischiorectal fossa with high fever Swelling – not localised Fluctuation - absent

18. TREATMENT In LITHOTOMY position, CRUCIATE shaped incision, Followed by DE ROOFING & DRAINAGE of pus Presence of any internal opening to rectum should be looked for

19. COMPLICATIONS Fistula-in-Ano Fournier’s Gangrene Deat h Fecal Incontinence

20. PROGNOSIS Drainage alone results in cure for 50%. 50% will have recurrences and develop an anal fistula.