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Back to Topics<<<< These are abscesses around the anal canal and the rectum. Types:
Origin: These abscesses result from the acute inflammation in anal glands. The pus collects in the space between the internal sphincter and the conjoined longitudinal muscle. Low intermuscular abscess is much more common than high intermuscular abscess. Clinical Features: The patient complains of throbbing pain inside the anal canal, aggravated after defaecation, and associated with fever and constitutional disturbances. On examination, nothing is evident from outside. A digital examination elicits swelling and acute tenderness in the wall of the anal canal, low or high depending on type of the abscess. Spread: Untreated, abscess may spread as follows:
Early incision, under antibiotic cover, is the treatment. A delayed, inadequate, or otherwise defective incision, or else, a spontaneous rupture of the abscess invariably lead to an anal fistula. (The abscesses demanding early incision are perianal abscess, breast abscess and hand infections). The incision is placed on the perianal skin and, in order to be adequate, always under general anaesthesia. A sinus forceps is thrust into the intermuscular space and the abscess is drained. A digital exploration is done to break all loculi. The internal sphincter is separated from the underlying mucosa and is cut through (i.e. a sphincterotomy is done). This is of great value in preventing fistula formation. The cavity is packed and allowed to heal by granulation. 2. Ischiorectal abscess Origin: Located in the ischiorectal fossa, the abscess may arise by:
Clinical Features: Apart from fever and constitutional symptoms, there is acute pain in the ischiorectal fossa, particularly during defaecation and on attempts to sit on the buttock. Treatment: Early incision under general anaesthesia. As the fossa is deep and as the overlying skin is considerably thick, fluctuation is elicited only very late, and incision should never be delayed to that date. A large crucial incision is made on the ischiorectal fossa. As the abscess drains, a digital exploration is made:
3. Subcutaneous, Subanodermal and Submucous Abscesses: These abscesses are superficial, lying just deep to the skin, anoderm, or mucous membrane, respectively. A small incision, on the overlying skin, anoderm, or mucosa provides easy drainage. Pelvirectal Abscess: These abscesses, fortunately rare, are located very deep and high up, between the rectum and the levator ani. They usually result from pelvic cellulites. The abscess may either burst into the rectum or penetrate downwards, through the levator ani, to present as an ischiorectal abscess. In the latter case, incision is made as for an ischiorectal abscess, and then the opening in the levator ani is enlarged to provide adequate drainage. This article has been written by Dr. M. Javed Abbas. If you have any comments please do not hesitate to sign my Guest Book. 00:55 10/02/2003 |