🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Perianal abscesses and fistulae

Medicine > Infection

Perianal Abscesses

Background Knowledge 🧠

Definition

  • A perianal abscess is a collection of pus in the tissues surrounding the anus and rectum.

Aetiology

  • Often result from infection of an anal gland which spreads to the perianal tissue.
  • Common organisms: Escherichia coli, Staphylococcus aureus, and mixed anaerobes.
  • Associated conditions: Inflammatory bowel disease, diabetes mellitus, immunosuppression, and trauma.

Clinical Features 🌡️

Clinical Features

  • Pain, swelling, and redness around the anus.
  • Possible fever and malaise.
  • Discharge of pus from the anus.

Management 🥼

Management

  • Incision and drainage is the primary treatment.
  • Antibiotics if cellulitis is present or if the patient is immunocompromised.

Perianal Fistulae

Background Knowledge 🧠

Definition

  • An abnormal tract or tunnel between the anal canal and the skin near the anus.

Aetiology

  • Often arises after a perianal abscess has drained, either spontaneously or surgically.
  • Other causes: Crohn’s disease, trauma, malignancy, tuberculosis, and radiation.

Clinical Features 🌡️

Clinical Features

  • Recurrent perianal abscesses.
  • Persistent discharge of pus or blood from the perianal skin.
  • Possible anal pain, itching, or irritation.

Investigations 🧪

Investigations

  • Examination under anaesthesia (EUA): To assess the extent and direction of the fistula.
  • MRI can help delineate the fistula tract, especially in complex or recurrent cases.
  • Fistulography: Contrast study but less commonly used due to the superior detail of MRI.

Management 🥼

Management

  • Fistulotomy: Surgically opening and laying open the fistula tract.
  • Seton placement: For complex or high fistulae. Helps to drain the fistula and can be tightened over time to cut through the fistula tract gradually.
  • Fibrin glue or fistula plug: Less invasive methods, but with a higher recurrence rate.
  • Management of underlying conditions such as Crohn’s disease.

Complications

  • Recurrence of abscess or fistula.
  • Anal incontinence, especially with repeated surgeries or high fistulae.
  • Sepsis if untreated.

Key Points

  • It’s important to approach patients with a suspected perianal abscess or fistula with a thorough clinical assessment, followed by appropriate investigations and timely management.

No comments yet 😉

Leave a Reply

Infection