Anorectal abscesses: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Anorectal abscesses (paraproctitis) are a limited accumulation of pus in the pararectal area. Abscesses usually develop in anal crypts. Symptoms are pain and swelling. The diagnosis is established when examining both CT or MRI of the pelvis with deeper abscesses. Treatment consists in surgical drainage.
Abscesses can be localized in various areas surrounding the rectum and are superficial (subcutaneous) or deep. Perianal abscesses are superficial under the skin. Ischiorectal abscess deeper, spreads from the sphincter to the ischiorectal space below the muscle that lifts the anus; An abscess can spread to the opposite side, forming an abscess in the form of a "horseshoe". The abscess is higher than the muscle that lifts the anus (ie, the axillary abscess, pelvio-rectal abscess), is located deep enough and can reach the peritoneum or abdominal organs; This abscess is often a consequence of diverticulitis or inflammatory pelvic disease. Sometimes anorectal abscess is a manifestation of Crohn's disease (especially of the large intestine). Usually there is a mixed infection, including Escherichia coli, Proteus vulgaris, Bacteroides, streptococci with a predominance of staphylococcus.
[Symptoms of anorectal abscess
Superficial abscesses can occur with severe pain syndrome; characterized by swelling in the perianal zone, hyperemia and pain. Deeper abscesses can be less painful, but cause signs of intoxication (eg, fever, chills, malaise). When examining the local signs of abscesses are sometimes absent, but with a finger examination of the rectum, it is possible to identify the tenderness of the intestinal wall and the fluctuating protrusion of the wall. High pelviorectal abscesses can cause pain in the lower abdomen and fever without signs from the rectum. Sometimes fever is the only symptom of the disease.
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Treatment of anorectal abscess
You can not expect a spontaneous breakthrough of the abscess, you need an urgent opening and adequate drainage of the abscess. Surface abscesses can be drained in an outpatient setting; deeper abscesses require drainage under operating conditions. Patients with fever or diabetes should be prescribed antibiotics (eg, ciprofloxacin 500 mg IV every 12 hours and metronidazole 500 mg IV every 8 hours, ampicillin / sulbactam 1.5 g IV every 8 hours); patients with subcutaneous abscesses do not need antibiotics. After drainage, anorectal fistulas can form.