Abscess - perirectal



BASIC INFORMATION
A perirectal abscess is a localized inflammatory process that can be associated with infections of soft tissue and anal glands based on anatomic location. Perianal and perirectal abscesses may be simple or complex, causing suppuration. Infections in these spaces may be classified as superficial perianal or perirectal with involvement in the following anatomic spaces: ischiorectal, intersphincteric, pestianal, and supraelevator.

SYNONYMS
Rectal abscess;
Perianal abscess;
Anorectal abscess.

EPIDEMIOLOGY & DEMOGRAPHICS
INCIDENCE (IN U.S.):
Commonly encountered
PREDOMINANT SEX: Male > female
PREDOMINANT AGE: All ages
PEAK INCIDENCE: Not seasonal; common
GENETICS: None known

PHYSICAL FINDINGS & CLINICAL PRESENTATION
• Localized perirectal or anal pain-often worsened with movement or straining
• Perirectal erythema or cellulitis
• Perirectal mass by inspection or palpation
• Fever and signs of sepsis with deep abscess
• Urinary retention
Perirectal Abscess
ETIOLOGY
Polymicrobial aerobic and anaerobic bacteria involving one of the above anatomic spaces, often associated with localized trauma.
Microbiology: most bacteria are polymicrobial, mixed enteric and skin flora
Predominant anaerobic bacteria:
Bacteroides fragilis
Peptostreptococcus spp.
Prevotella spp.
Fusobacterium spp.
Porphyromonas spp.
Clostridium spp.
Predominant aerobic bacteria:
Staphylococcus aureus
Streptococcus spp.
Escherichia coli
DIAGNOSIS
Many patients will have predisposing underlying conditions including:
• Malignancy or leukemia
• Immune deficiency
• Diabetes mellitus
• Recent surgery
• Steroid therapy
DIFFERENTIAL DIAGNOSIS
• Neutropenic enterocolitis
• Crohn’s disease (inflammatory bowel disease)
• Pilonidal disease
• Hidradenitis suppurativa
• Tuberculosis or actinomycosis; Chagas’ disease
• Cancerous lesions
• Chronic anal fistula
• Rectovaginal fistula
• Proctitis-often STD-associated, including:
Syphilis
Gonococcal
Chlamydia
Chancroid
Condylomata acuminata
• AIDS-associated:
Kaposi’s sarcoma
Lymphoma
CMV
WORKUP
• Examination of rectal, perirectal/ perineal areas
• Rule out necrotic process and crepitance suggesting deep tissue involvement
• Local aerobic and anaerobic culture
• Blood cultures if toxic, febrile, or compromised
• Possible sigmoidoscopy
TREATMENT
• Incision and drainage of abscess
• Debridement if necrotic tissue
• Rule out need for fistulectomy
• Local wound care-packing
• Sitz baths
Antibiotic treatment: Directed toward coverage for mixed skins and enteric flora
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