ANORECTAL ABSCESS

Assoc. Prof. Dr. Fevzi Cengiz, FTBS, FEBS-c, FACS
İzmir Katip Celebi University, Faculty of Medicine, Department of General Surgery, İzmir, Türkiye

ABSTRACT

Anorectal abscess is a pus-filled pathological formation that occurs when one of the anal glands in the anal crypts, usually at the level of the dentate line, obstructs the drainage channel. When the anal gland duct is obstructed, the increase in bacteria due to stasis causes inflammation and abscess development. 30-70% of anal abscesses also have fistulae. In 50% of abscesses without fistula, fistula will develop in the following periods. The classification of anal abscesses is predominantly based on their anatomical location in relation to the sphincter complex and adjacent tissues. The main types include perianal, ischiorectal, intersphincter- ic, supralevator, and submucosal abscesses . Perianal abscesses, the most frequently encountered type, are typically located just beneath the skin around the anal verge and are usually visible on physical examination. Anal abscess is diagnosed by anamnesis, physical examination and imaging methods if necessary. Severe anal pain is the most common complaint. Swelling is present with pain. CT, MRI and EUS can play a role in the diagnosis of perianal abscesses with the main objectives of excluding related conditions and accurately determining the regional anatomy and extent of disease; the selection of the appropriate imaging examination should take into account multiple factors such as the patient’s medical history, clinical presentation, local resource availability and skills. Surgical drainage is still the main treatment for anorectal abscess. When it is diagnosed, whole perianal and perirectal abscesses should be drained urgently; lack of physical examination findings like fluctuance must not stop surgeon to delay intervention. Undrained anorectal abscess can cause serious systemic infection.

Keywords: Anorectal abscess; Anal fistula; Anal gland; Drainage; Emergency surgery

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