Perianal Abscesses and Fistula Flashcards
what is a perineal abscess
pus collecting in the perineal region
what is a perineal fistula
abnormal chronically infected tract betweem the perineal skin and either the anal canal or the rectum
what causes perineal abscesses and fistulae
bacterial infection,
fistulae can develop as a complication of an abscess or Crohns disease
what is the development of multiple perineal fistulae in crohn’s disease called
pepper pot perineum
risk factors of perineal abscesses and fistula
IBD, diabetes mellitus and malignancy and anal fistula
presenting symptoms of anal abscesses and fistulae
throbbing perianal pain
perianal swelling
intermittent discharge (mucus or faecal staining) near the anal region
personal/ family Hx of IBD
what signs will be present on examination
localised tender perineal mass, on DRE you may see the opening of the anal fistula
why may a DRE not be suitable/ done
due to pain and the anal sphincter spasm
what investigations will be done
Bloods- FBC, CRP, ESR, blood culture
imaging; MRI (most suitable)
what is Goodsall’s Rule
If the external opening is anterior to the transverse anal line, the tract runs radially in a straight line, and the internal opening is anterior to the transverse anal line.
If the external opening is posterior to the transverse line (or anterior to the transverse anal line but more than 3 cm away from the rectum), the tract runs a curved path to open at the 6 o’clock position (posteriorly).
treatment of the perineal abscess and fistulae
surgical treatment- open drainage of the abscess
complications?
recurrence (high probability),
incontinence and persisting pain
