Anorectal abscess: Difference between revisions
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****Rectal pain, skin signs may not be present | ****Rectal pain, skin signs may not be present | ||
****Constitutional symptoms often present | ****Constitutional symptoms often present | ||
==Risk Factors== | |||
*Crohn’s disease | |||
*Chronic constipation | |||
*Diabetes mellitus | |||
*Chronic corticosteroid use | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 13:49, 9 February 2015
Background
- Usually begin via blocked anal gland (leads to infection/abscess formation)
- Can progress to involve any of the potential spaces:
- Perianal
- Most common
- Located close to anal verge, posterior midline, superficial tender mass
- Ischiorectal
- 2nd most common
- Larger, indurated, well-circumscribed, located laterally on medial aspect of buttocks
- Intersphincteric, deep postanal, pelvirectal
- Rectal pain, skin signs may not be present
- Constitutional symptoms often present
- Perianal
- Can progress to involve any of the potential spaces:
Risk Factors
- Crohn’s disease
- Chronic constipation
- Diabetes mellitus
- Chronic corticosteroid use
Clinical Features
- Worsening pain around bowel movement, with decreased pain post rectal evacuation
- Perirectal abscesses often accompanied by fever, leukocytosis
- May only be paplpated via digital rectal exam
- Tender inguinal adenopathy may be only clue to deeper abscesses
Diagnosis
- CT or US can be useful to define deep abscesses (esp w/ pain out of proportion to exam)
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Hemorrhoids
- Pedunculated polyp
- Pilonidal cyst
- Proctitis
- Pruritus ani
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Treatment
- All perirectal abscesses should be drained in the OR
- Common bacteria: Staphylococcus aureus, Escherichia coli, Streptococcus, Proteus and Bacteroides
- Isolated perianal abscess is only type of anorectal abscess that should be treated in ED
- Consider either linear incision w/ packing or cruciate incision w/o packing
- Frequent sitz baths
- Abx
- Only indicated for:
- Elderly
- Systemic signs (fever, leukocytosis)
- Valvular heart disease
- Cellulitis
- Immunosuppression
- Piperacillin-tazobactam 3.37gm IV q6hr OR ampicillin-sulbactam 3gm IV q6hr
- Only indicated for:
See Also
Source
Tintinalli