IGNORE AFTER THIS [31] Anorectal Abscess

Question 1

What is an anorectal abscess?

Answer 1

A collection of pus in the anal or rectal region

Question 2

Which gender are anorectal abscesses more common in?

Answer 2

Men

Question 3

What are anorectal abscesses thought to be caused by?

Answer 3

Plugging of the anal ducts

Question 4

What are the anal ducts?

Answer 4

Structures found in the wall of the anal canal which drain the anal glands

Question 5

What do the anal ducts do?

Answer 5

Secrete mucus into the anal canal to ease the passage of faecal matter

Question 6

What does blockage of the anal ducts cause?

Answer 6

Stasis

Question 7

What does stasis caused by the blockage of the anal ducts allow?

Answer 7

Normal bacterial flora to overgrow, leading to infection

Question 8

What are the common causative organisms for infection in anorectal abscesses?

Answer 8

E. Coli
Bacteroides
Enterococcus

Question 9

Where are the anal glands located?

Answer 9

In the intersphincteric space

Question 10

What is the intersphincteric space?

Answer 10

The space between the internal and external anal sphincters

Question 11

What can happen once infection has started in the anal glands?

Answer 11

Infection can spread to adjacent areas

Question 12

What can anorectal abscesses be classified on the basis of?

Answer 12

Where they occur

Question 13

What are the classifications of anorectal abscesses?

Answer 13

Perianal
Ischiorectal
Intersphincteric
Supralevator

Question 14

What course do anorectal abscesses take?

Answer 14

They are typically intermittent in nature

Question 15

How do anorectal abscesses present?

Answer 15

Pain in perianal region, which is exacerbated when sitting down
Localised swelling, itching, or discharge

Question 16

What symptoms might be caused by severe anorectal abscesses?

Answer 16

Systemic features, such as fever, rigors, general malaise, or sepsis

Question 17

What will be found on examination in anorectal abscess?

Answer 17

The abscess will be red and tender, and may be discharging purulent or haemorrhagic fluid
Likely be some degree of surrounding cellulitis

Question 18

How is a diagnosis of superficial anorectal abscess made?

Answer 18

Clinically

Question 19

What will DRE often reveal in anorectal abscesses?

Answer 19

Fluctuant tender mass

Question 20

What is the limitation of DRE in anorectal abscess?

Answer 20

Many patients cannot tolerate this, and require examination under anaesthesia

Question 21

What investigation might complicated or chronic anorectal abscesses require?

Answer 21

Imaging, typically MRI

Question 22

Which anorectal abscess patients are systemic features more likely to occur in?

Answer 22

Patients who are immunocompromised

Those with ischiorectal abscesses

Question 23

Why is there little room for conservative management of anorectal abscesses?

Answer 23

As they have high rates of recurrence and the development of fistulae

Question 24

What is the role of antibiotics in anorectal abscesses?

Answer 24

Antibiotics may be utilised initially for acute infective states, especially in diabetes or immunocompromised patients, but should not be used routinely

Question 25

What is the main management of anorectal abscesses?

Answer 25

Surgical drainage

Question 26

Is surgical drainage of an anorectal abscess typically performed under local or general anaesthesia?

Answer 26

General

Question 27

Why should drainage of an anorectal abscess be performed in a timely manner?

Answer 27

To prevent tissue damage, including anal sphincter dysfunction

Question 28

How do anorectal abscesses heal following drainage?

Answer 28

Secondary intention

Question 29

Should there ever be an attempt for early closure of an anorectal abscess?

Answer 29

It is not advised

Question 30

What may be considered by experienced surgeons in anorectal abscesses?

Answer 30

The insertion of a seton

Question 31

When is the insertion of a seton performed in anorectal abscess?

Answer 31

Typically only if the tract is identifiable with minimal probing