ANORECTAL ABSCESS AND FISTULA
Anorectal abscesses and anal fistulas are disease processes that have their basis of understanding and treatment firmly rooted in the anatomic design of the anal canal. The potential for disastrous complications is real. Careful, thorough, and meticulous care in the diagnosis and treatment of fistulous abscesses will result in successful outcomes in most cases. Perirectal and perianal abscess are commonly encountered problems in surgical practice. Timely and appropriate treatment is needed to prevent serious morbidity and mortality. Differentiation of the more complex perirectal abscess from the perianal abscess is crucial.
Pathophysiology
Perirectal abscess arises from infection of the mucus-secreting anal glands, which drain into the anal crypts. Blockage of the duct is believed to be the initiating cause of infection. The abscess can then progress to involve the potential spaces filled with fatty areolar tissue, which have little resistance to infection. These spaces include the perianal, intersphincteric, ischiorectal, deep postanal space, which connect the ischiorectal space on each side posteriorly, and supralevator spaces. These spaces may become infected alone or in combination with one another. Perirectal abscess is…show more content… Perirectal abscess can be extensive and can spread to an area distant from the anal verge (Figure 3), yet only a diffuse, tender mass may be palpable through either the rectal wall or the overlying skin. The overlying skin may look normal or inflamed depending upon the depth of the suppurative focus. The patient is febrile, localize erythema may be noted. Purulent discharge per anus may be seen or found during digital rectal examination or anoscopy. Signs of sepsis may be seen in the form or toxemia. In a neglected case, septicemia may