PERIANAL ABSCESS & PILONIDAL DISEASE MANAGEMENT

Presented by: Khawar Hashmi CT-2 General Surgery Royal Glamorgan Hospital

INTRODUCTION
Perianal diseases are common diseases These conditions are extremely

embarrassing and distressing Patients put up with their condition for a long time Therefore, they seek medical care late

ANATOMY
The anal canal is 1.5 inch (4 cm) long Directed downward and backward from

the rectum Ends at the anal Orifice The mid of the anal canal represents the junction between Endoderm and Ectoderm Separated by the dentate line into two halves

COMPARISON BETWEEN THE HALVES

Upper : Lined by Columnar

epithelium Supplied by Superior rectal vessels Lymphatic drainage to lumbar lymph nodes Nerve supply by Autonomic plexus

Lower : Lined by stratified

squamouse Epithelium Supplied by Inferior rectal vessels Lymphatic drainage to Inguinal lymph nodes Nerve Supply by Terminal Branch of pudendal

ANAL SPHINCTER
The internal anal sphincter is involuntary
muscle which is the continuation of the circular muscles of the rectum the External anal sphincter is voluntary muscle which surrounds the internal sphincter

APPROACH TO ACUTE PERIANAL CONDITION

History Physical examination Digital rectal Examination Proctoscopy Sigmoidoscopy

HISTORY
Pain analysis (site, character, onset,
duration, progressive, relieved by, exacerbated by, associated with) Constipation, discharge, bleeding, relation to defecation, itching, swelling or lump Fever, malaise, at night, labour, loss of appetite, sweating Diet Anal intercourse

ANORECTAL EXAMINIATION AND PROCTOSCOPY

Focuses on the general condition of the patient Abdominal examination is mandatory Followed by Anorectal Examination Anorectal Examination : 1. Inspection 2. Palpation (DRE) Sigmoidoscopy Proctoscopy

ANORECTAL ABSCESS
The infection starts in one of the
crypts of Morgagni extends along the related anal gland to the inter sphincteric plane where it forms as abscess. Soon it tracks in various directions to produce different types of abscesses.

TYPES OF ABSCESSES
1.
2. 3.

4.

Perianal abscess (60%) Ischiorectal abscess (30%) Sub mucous abscess (5%) Pelvirectal abscess Recurrence of an anorectal abscess indicates an underlying illness (UC, Crohn's disease, rectal CA or TB

ANORECTAL ABSCESS
High risk groups include diabetics, immunocompromised patients, people who engage in receptive anal sex, and patients with inflammatory bowel disease. The male to female ratio is approx. 2:1 The most common organisms * E.coli (60%) * Staph. aureus (23%)

 Most common underlying condition is

Fistula in ano

CLINICAL FEATURES AND TREATMENT

Symptoms: Acute pain High fever Signs: Swelling Tenderness with induration Treatment: (if there is pus about let it out) Incision and drainage and if complicated, covered by antibiotics. Drainage us under GA followed by sigmoidoscopy and proctoscopy

POST DRAINAGE COMPLICATIONS

Fistula in ano Recurrence Perianal sepsis (60% incidence) Ischiorectal sepsis (30% incidence) Management of those is by drainage

through the perineal skin through a cruciate incision most fluctuant point and then de-roof the abscess

PILONIDAL SINUS
The word pilonidal means nest of hair Sinus that contains broken tuft of hairs

sometimes without hair Usually found in the skin over the sacrum Barbers get it in interdigital clefts

PILONIDAL SINUS
Big argument about the etiology and
mechanism The patient presents with pain and discharge often a man usually dark haired and hirsute young man less than 30 Position is misleading Mistaken to be an anal fistula At the mid line of the natal cleft

Examination
As for Perianal abscess EUA Probing Sinogram MRI

MANAGEMENT
Oral antibiotics Excision with or without closure Kerry-Deckers Procedure Flap rotations

THANK YOU
The End