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Based on the location of the abscess in relation to the anal canal and the spread of infection to the surrounding structures anal abscess can be classified into : | Based on the location of the abscess in relation to the anal canal and the spread of infection to the surrounding structures anal abscess can be classified into : | ||
*'''Perianal abscess:'''When the infection reaches the anal verge passing between the internal and external sphincter, it results in the formation of a perianal abscess. | |||
*'''Ischiorectal abscess:'''If the infection ruptures through the external sphincter it results in a formation of a ischiorectal abscess. | |||
*'''Supralevator abscess:'''If the infection extends superiorly, it can form a supralevator abscess. | |||
*'''Horseshoe abscess:'''Extension of the anal abscess to both the ischiorectal fossa results in the formation of a horseshoe abscess. | |||
==Pathophysiology== | ==Pathophysiology== | ||
Revision as of 15:55, 7 March 2017
Overview
Historical Perspective
- In 1880, Herman and Desfosses described the anal glands within the internal sphincter, sub-mucosa and their opening into the anal crypts and demonstrated that the infection of these glands and the spread of the infection through the intersphincteric space can result in the formation of a anal abscess.[1]
- Tucker and Hellwig, provided evidence that the initial infection occurs in the anal ducts allowing the infection to spread from the anal lumen into the anal canal wall.[1]
- In 1950, Goligher described the treatment for anal abscess with inicision and curettage with antibiotic bath and primary closure.[1]
Classification
Based on the location of the abscess in relation to the anal canal and the spread of infection to the surrounding structures anal abscess can be classified into :
- Perianal abscess:When the infection reaches the anal verge passing between the internal and external sphincter, it results in the formation of a perianal abscess.
- Ischiorectal abscess:If the infection ruptures through the external sphincter it results in a formation of a ischiorectal abscess.
- Supralevator abscess:If the infection extends superiorly, it can form a supralevator abscess.
- Horseshoe abscess:Extension of the anal abscess to both the ischiorectal fossa results in the formation of a horseshoe abscess.
Pathophysiology
Pathogenesis
- Anal canal is a 2 to 4cm in length, starts at the anorectal junction to the end of anal verge.[2]
- It is divided into a upper and a lower part by transition zone that is seen at the dentate or pectinate line which is surrounded by longitudinal mucosal folds, called columns of morgagni.[2]
- Each of this fold contains anal crypts, each of which contains 3 to 12 anal glands, the distribution of these glands is not uniform with most of the glands present anterior to the position of the anal canal and fewer in the posterior position.[2]
- The initial infection occurs in the ducts of the anal glands and the spread of infection results in the formation of the abscess, various theories were put forward to describe the pathogenesis and the most accepted one is the cryptoglandular theory.[3]
- The crytoglandular theory states that when a anal gland duct is obstructed, it results in a infection and due to the presence of these glands deep in relation to the anal canal and sphincter, the infection follows the path of least resistance resulting in a abscess formation at the termination of the gland.[4]
Causes
Epidemiology and Demographics
Incidence
- The incidence of anorectal abscess is estimated to be around 68,000 to 96,000 cases per year in the United States.[1]
Gender
- Anal abscesses are two times more frequently seen in men than women.[5]
Age
- Patients with anal abscess present between ages of 20 to 60 years with a mean age of 40 in both sexes.[1]
Race
- There are limited epidemiological studies which studied the frequency of anal abscess with race differences, however a study in Chicago showed that 92% of the patients presented with anal abscess were African population.[6]
Risk Factors
Differential Diagnosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Treatment
Medical Therapy
Surgical Therapy
- Management of anal abscess should be prompt as the risk of involving the surrounding tissue resulting in perineal cellulitis and sepsis is high.[7]
- Emergency treatment for anal abscess is incision and drainage under local anesthesia if the abscess is superficial.
- If the abscess is deep seated surgical drainage under general anesthesia is preferred.
Prevention
Primary Prevention
Secondary Prevention
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Abcarian H (2011). "Anorectal infection: abscess-fistula". Clin Colon Rectal Surg. 24 (1): 14–21. doi:10.1055/s-0031-1272819. PMC 3140329. PMID 22379401.
- ↑ 2.0 2.1 2.2 "Anatomy and Embryology - Springer".
- ↑ Rickard MJ (2005). "Anal abscesses and fistulas". ANZ J Surg. 75 (1–2): 64–72. doi:10.1111/j.1445-2197.2005.03280.x. PMID 15740520.
- ↑ PARKS AG (1961). "Pathogenesis and treatment of fistuila-in-ano". Br Med J. 1 (5224): 463–9. PMC 1953161. PMID 13732880.
- ↑ Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T (2012). "German S3 guideline: anal abscess". Int J Colorectal Dis. 27 (6): 831–7. doi:10.1007/s00384-012-1430-x. PMID 22362468.
- ↑ Read DR, Abcarian H (1979). "A prospective survey of 474 patients with anorectal abscess". Dis Colon Rectum. 22 (8): 566–8. PMID 527452.
- ↑ Slauf P, Antoš F, Marx J (2014). "[Acute periproctal abscesses]". Rozhl Chir. 93 (4): 226–31. PMID 24881481.