Anorectal Abscess

It is an infection of the anal glands in the anal crypts at the dentate line. An initial abscess occurs in the inter-sphincteric space and can then spread;

• Caudally to present as a perianal abscess
• Laterally across the external sphincter to form an ischiorectal abscess or,
• Superiorly above the anorectal junction to form a supralevator intermuscular or pararectal abscess

Anatomical classification

• Perianal (60%)
• Ischiorectal (20%)
• Inter-sphincteric (5%)
• Supralevator (4%)
• Submucosal (1%)

Clinical Presentation

• Pain in the perianal area is dull, aching, or throbbing, worse on sitting and right before a bowel movement.
• Examination reveals a small, erythematous, well-defined, fluctuant, subcutaneous mass near the anal orifice.

Treatment

Surgical drainage with skin incision close to the anal verge

Indications for antibiotics;

• Immunocompromised patient
• Diabetic
• Extensive cellulitis
• Valvular heart disease

Post-op: Analgesia, stool bulking agents and stool softeners

Complications

• Sepsis
• Anal fistula