Perianal abses

[Surgical alternatives in the treatment of anal abscesses]

[Article in Spanish]

Charua-Guindic L, Cantu-Marroquin JA, Osorio-Hernandez RM, Navarrete-Cruces T, Avendano-Espinosa O.

Unidad de Coloproctologia, Servicio de Gastroenterologia, Hospital General de Mexico. luischarua@hotmail.com

INTRODUCTION: Anal abscess is a pus collection localized in some of the regions around the anus and rectum. We reviewed the experience in the management of abscesses in Coloproctology Unit at the Gastroenterology Service in the General Hospital of Mexico. MATERIAL AND METHODS: This is a retrospective, longitudinal and descriptive study in patients diagnosed as carriers of an anal abscess during the period from January 1998 to December 2002. RESULTS: During this period, 9,233 first consultations took place, 241 fulfilled inclusion criteria: 197 (81.74%) were male and 44 (18.25%) were female. Perianal abscesses affected 156 patients (64.73%), 51 ischiorectal abscesses (21.16%), 17 horseshoe (7.05%), 14 intersphincteric (5.80%) and 3 has supralevator abscesses (1.24%). CONCLUSIONS: There were 96.68% nonspecific anal abscesses. Simple drainage is an initial adequate management. Most patients (73%) were attended in the office. Pain was the most common symptom (99%). Perianal and ischiorectal localizations were the most frequently classified and there was no mortality. PMID: 16336800 [PubMed - indexed for MEDLINE]

A prospective survey of 474 patients with anorectal abscess. Read DR, Abcarian H.
A prospective survey of patients with anorectal abscesses treated at Cook County Hospital over a 35-month period produced data on 474 patients. The peak incidence was in the third decade of life. Males were affected 1.76 times more frequently than females. Perianal abscess was the most common anatomic type (42 per cent), with ischiorectal abscess (20 per cent) being second. The supralevator space was involved in 7 per cent of the abscesses. Primary fistulotomy was performed when an anal fistula could be demonstrated (34 per cent). Our standardized method of treatment, utilizing radial incisions for drainage, produced satisfactory results with a complication rate of 3 per cent, an

in-hospital reoperation rate of 0.6 per cent, and an average hospital stay of 5.7 days. PMID: 527452 [PubMed - indexed for MEDLINE]

Supralevator abscess: diagnosis and treatment. Prasad ML, Read DR, Abcarian H.
Anorectal suppurations are quite common. Supralevator abscesses, previously regarded as a rare subgroup, were seen in 9.1 per cent of 506 patients admitted to Cook County Hospital in a two-year period. Aggressive supportive management was followed by early, adequate drainage through the rectum whenever indicated. When fistulas were identified, either a primary fistulotomy or a two-stage fistulotomy using a seton was performed in the majority of cases. Important factors in the prevention of morbidity and mortality included debridement of all necrotic tissue, careful bacteriologic studies and judicious use of antibiotics, close postoperative observation, and long-term follow-up of the patients. PMID: 7273983 [PubMed - indexed for MEDLINE]

Perianal abscesses and fistulas. A study of 1023 patients.

Ramanujam PS, Prasad ML, Abcarian H, Tan AB. In a five and one-half year period, 1023 patients with anorectal abscesses and fistulas were treated. Under regional anesthesia the abscesses were unroofed and debrided and a primary fistulotomy was performed whenever a low fistula was identified. In 355 (34.7 per cent) an internal fistulous opening was demonstrated at the time of abscess drainage. Thirty-two patients had suprasphincteric fistulas and underwent two-stage fistulotomy using a seton. Perianal abscesses were encountered in 42.7 per cent of the patients, followed by ischiorectal (22.7 per cent), intersphincteric (21.4 per cent), and supralevator (7.33 per cent). The patients with supralevator and intersphincteric abscesses had a high incidence of fistula identified during abscess drainage. The recurrence rates were 3.7 per cent in the group with abscess drainage only and 1.8 per cent in the group that had primary fistulotomy along with abscess drainage. The follow-up period averaged 36 months. To accomplish adequate drainage and identify the deeper components and associated fistulous opening (34.7 per cent

of the entire group), careful examination under regional anesthesia is recommended. Early aggressive treatment of an anorectal abscess and fistula significantly reduces the possibility of recurrent abscesses and/or the need for further surgery. PMID: 6468199 [PubMed - indexed for MEDLINE]

[Experience on the treatment of acute anorectal abscess with primary fistulotomy]

[Article in Chinese]

Wu CL.
Department of Surgery, Kuang Tien General Hospital, Taichung County, Taiwan, Republic of China.

From August 1985 to July 1989, 72 cases with initial attacks of acute cryptoglandular anorectal abscesses were hospitalized and treated in Kuang Tien General Hospital. Among them were 52 cases of the perianal type, 8 of the intersphincteric type, 11 of the ischiorectal type and one case involving the supralevator space. Included were 62 males and 10 females (sex ratio 6:1) with a mean age of 39 years (range, 18 to 63). The mean duration of the follow-up was 24 months. Most anorectal abscesses originate from a cryptoglandular infection and are usually treated initially by incision and drainage. However, a fistula operation may be required if a fistula develops weeks or months later. Several published papers from various hospitals have also pointed out that this disease condition can be successfully treated by a one-stage operation-primary fistulotomy. In order to determine the source of infection, careful examination was carried out in the operating room under adequate anesthesia. A definite or at least a highly suspected offending crypt was found in 57 cases, all of whom were treated by primary fistulotomy. The remaining 15 cases whose offending crypts were undetectable, were treated by incision and drainage. Of the 57 cases treated with primary fistulotomy, four cases developed recurrent abscesses or fistulas. In the incision and drainage group, five cases developed recurrences. Among the nine cases of recurrence, five were of the ischiorectal type. The author surmises that acute anorectal abscess of the ischiorectal type was rarely cured by the one-stage primary fistulotomy operation. However, for the majority of perianal and intersphincteric abscesses, primary fistulotomy should be the first choice of management. PMID: 2362300 [PubMed - indexed for MEDLINE]

Management of anorectal horseshoe abscess and fistula. Held D, Khubchandani I,

Sheets J, Stasik J, Rosen L, Riether R. Over a 10-year period 69 patients were treated consecutively for posterior and anterior horseshoe abscesses and fistulas. Fifty-nine patients had posterior and ten had anterior abscesses or fistulas. There were 52 patients with acute abscess. Treatment consisted of incision and drainage, incision and drainage with primary fistulotomy, incision and drainage with primary fistulotomy and counter-drainage, and incision and drainage with insertion of seton. Seventeen patients with chronic fistulas were treated by primary fistulotomy with curettage, or incision and drainage with insertion of seton. Patients were followed from three months to ten years with a mean follow-up of three years. No incidences of incontinence were reported in this series. The overall rate of recurrence was 18 percent, and included only patients with posterior abscesses and fistulas. Recurrence was related to the failure to maintain prolonged drainage in the midline after primary fistulotomy. The use of seton for delayed fistulotomy appears to promote wound drainage and precludes premature wound closure. More liberal use of the seton in the treatment of horseshoe abscesses and fistulas is advocated. PMID: 3792160 [PubMed - indexed for MEDLINE]