We present a 52 year old diabetic patient who presented initially with perianal abscess. After a week he presented with abdominal wall cellulitis which soon progressed to an abscess which involved the entire abdominal wall circumferentially. [ijsurgery.com]

PRESENTATION OF CASE A previously healthy sixty-five year old man presented emergently with rectal pain, weight loss and recurrent severe tension headaches. [ncbi.nlm.nih.gov]

• Fever

  High pelvirectal abscesses may cause lower abdominal pain and fever without rectal symptoms. Sometimes fever is the only symptom. [msdmanuals.com]

  Symptoms are severe throbbing pain near the anus with swelling and fever; it may cause an anal fistula. Pus is drained from the abscess by surgical incision. [oxfordreference.com]

  Release of pus Constipation Pain during bowel movements Fever bleeding When the abscess is superficial the person can actually feel the lump of swollen mass near the anus. [hegdehospital.com]

  However, if you experience excessive rectal bleeding, fever, chills, or vomiting after returning home from the procedure, call your doctor immediately. [verywellhealth.com]

  Symptoms are severe throbbing pain near the anus with swelling and fever; it may cause an anal fistula. Pus is drained from the abscess by surgical incision. A Dictionary of Nursing [encyclopedia.com]

• Malaise

  Fever and malaise are common. There may be associated pain on defecation. On examination, which should include a digital rectal examination, there may be a palpable area of fluctuance. There may also be overlying cellulitis. [visualdx.com]

  […] away from anus Due to obstruction of anal gland or crypt Etiology Polymicrobial Diagnosis Swelling, erythema, & flatulence Tender perianal or rectal mass Pain worse with defecation, sitting, walking Continuous throbbing perianal pain May have fever, malaise [fprmed.com]

  Systemic symptoms such as fever and malaise are common. With spontaneous opening, purulent rectal drainage may be seen. On physical ... [accesssurgery.mhmedical.com]

  Deeper abscesses may be less painful but cause toxic symptoms (eg, fever, chills, malaise). There may be no perianal findings, but digital rectal examination may reveal a tender, fluctuant swelling of the rectal wall. [msdmanuals.com]

  Severe abscesses may present with systemic features* such as fever, rigors, general malaise or sepsis. On examination, an abscess will be red and tender and may be discharging purulent or haemorrhagic fluid. [teachmesurgery.com]

• Severe Pain

  Ischiorectal Abscess can cause severe pain and swell with fever. There are several types of abscess formed depending on the location of their formation. An ischiorectal abscess is formed in the deeper tissues of the anal canal. [hegdehospital.com]

  Severe pain is also commonly seen during bowel movements Anorectal Abscess commonly affects individuals in the age group of 30-40 years. [dovemed.com]

  PERIANAL ABSCESS-CLINICAL FEATURES •SEVERE PAIN in perianal region with difficulty to sit •O/E- tender,smooth,soft ,swelling in the region 12. [slideshare.net]

  Diagnosis Anorectal abscess should be suspected in patients who present with severe pain in the anal or rectal area. [aischannel.com]

  pain in the perianal region, worse with direct pressure (i.e. when sat down), alongside potential perianal discharge or bleeding. [teachmesurgery.com]

• Asymptomatic

  He was discharged home and was asymptomatic on outpatient follow up six months later. He has decided that he will not consent to any future surgical intervention (including stoma closure). [ncbi.nlm.nih.gov]

• Fatigue

  It causes extreme pain, fatigue, rectal discharge, and fever. In some cases, anal abscesses can result in painful anal fistulas. This occurs when the abscess doesn’t heal and breaks open on the surface of the skin. [healthline.com]

  As the pus starts to consolidate and form a palpable mass, other symptoms of an anorectal abscess appear, including: Fever Fatigue Constipation Rectal discharge and bleeding Feeling like you need to go to the bathroom when you don’t Increasing and [verywellhealth.com]

  Other symptoms may include: Constipation Discharge of pus from the rectum Fatigue, fever, night sweats, and chills Redness, painful and hardened tissue in the area of the anus Tenderness In infants, the abscess often appears as a swollen, red, tender [medlineplus.gov]

  Fatigue : A specially seen in cases with bigger abscesses. Pain in abdomen : There is pain and discomfort in the lower abdomen in some cases. [proctocure.com]

• Constipation

  Constipation or tenesmus may be present in patients that have significant pain with a bowel movement. [statpearls.com]

  You can get tears in the skin if you are constipated. Being constipated means it is hard for you to have a BM. Pushing too hard can cause the tissue in the rectum to tear. [drugs.com]

  […] disease Chronic granulomatous disease (especially Crohn disease) Immunodeficiency disorders Hematologic malignancies (5–8% have anorectal abscess at some time) Diabetes mellitus Chronic medical immunosuppression Morbid obesity General Prevention Avoid constipation [unboundmedicine.com]

  As the pus starts to consolidate and form a palpable mass, other symptoms of an anorectal abscess appear, including: Fever Fatigue Constipation Rectal discharge and bleeding Feeling like you need to go to the bathroom when you don’t Increasing and [verywellhealth.com]

  His previous medical history included chronic constipation and intermittent urinary retention over the preceding five years. [ncbi.nlm.nih.gov]

• Fecal Incontinence

  References: [1] [5] [3] Treatment Fistulae Postoperative complications Painful defecation Fecal incontinence Urinary retention References: [4] [1] [6] [5] [7] [amboss.com]

  COMPLICATIONS Fistula-in-Ano Fournier’s Gangrene Death Fecal Incontinence 20. PROGNOSIS Drainage alone results in cure for 50%. 50% will have recurrences and develop an anal fistula. [slideshare.net]

  These lesions can cause significant anorectal pain, urinary retention, and fecal incontinence. In addition, the quality of life in patients with recurrence is poor. [statpearls.com]

  WHAT IS FECAL INCONTINENCE? Fecal incontinence (also called anal or bowel incontinence) is the impaired ability to control the passage of gas or stool. This is a common problem, but often not discussed due to embarrassment. [fascrs.org]

• Abdominal Pain

  System(s) affected: gastrointestinal, skin/exocrine Synonym: perianal abscess; perirectal abscess Geriatric Considerations A high pelvirectal abscess may cause minimal symptoms (lower abdominal pain and fever). [unboundmedicine.com]

  High pelvirectal abscesses may cause lower abdominal pain and fever without rectal symptoms. Sometimes fever is the only symptom. [msdmanuals.com]

  or as directed by your healthcare provider Other symptoms such as rectal bleeding, abdominal pain, or chronic diarrhea. [fairview.org]

  […] in the anal area or buttocks Pus drainage near the anus Fever A lump in the anal area Painful bowel movements Lower abdominal pain Fatigue Swelling in the anal area or buttocks Night sweats When to Seek Medical Care for an Anal Abscess If a person suspects [emedicinehealth.com]

  The patient had acute signs, abdominal pain, and mass lesions accompanying oppressive pain upon rectal examination. [ncbi.nlm.nih.gov]

• Anal or Rectal Pain

  Symptoms of an abscess include anal or rectal pain, itching, swelling, and fever. Frequently the abscess results in a fistula, which is an abnormal connection between the abscess and the skin where pus drains. [fairview.org]

  An anorectal abscess (also referred to as an anal abscess, rectal abscess, perianal abscess, or perirectal abscess depending on its location) is a pus-filled cavity that forms within the furrows of the anal canal (called the anal sinuses). [verywellhealth.com]

  For patient education resources, see the Esophagus, Stomach, and Intestine Center and the Digestive Disorders Center, as well as Anal Abscess, Rectal Pain, and Rectal Bleeding. [emedicine.medscape.com]

• Abdominal Distension

  He presented abdominal distension, diffuse peritonism and right ischiorectal erythema. [elsevier.es]

  The patient complained of vomiting, abdominal distension and pain. X-ray abdomen showed air in the retro-peritoneal space on the left side [Fig. 1] with paralytic ileus. [jpgmonline.com]

• Dermatitis

  Perianal dermatitis This condition usually presents with the complaint of irritation. It has usually been there for some time as patients are reluctant to present. The patient may have a history of eczema elsewhere, but this is often not the case. [gponline.com]

  Candida Crohn’s disease Psoriasis Diabetes mellitus Seborrheic dermatitis Condyloma acuminata Fissures Pediculosis pubis Erythema multiforme Herpes simplex/zoster Iron deficiency anemia Mycosis fungoides Uremia Contact dermatitis Non-sexual bacterial [ahcmedia.com]

• Hirsutism

  It mainly affects young hirsute males and is almost never seen in prepubescent subjects. The sinus may consist of a single track, but commonly there may be subsidiary lateral tracks extending on either side to the buttocks. [surgwiki.com]

• Withdrawn

  The buttocks are gently stretched apart and, providing the examiner is looking, a fleeting glimpse of the fissure will be obtained before sphincter contraction causes it to be withdrawn from view. [surgwiki.com]

• Seizure

  Cerebral 960 Pneumothorax 962 Poisoning Gastric Decontamination 968 Dysfunctional Uterine Bleeding 336 Retropharyngeal Abscess 970 Polycythemia 974 Rib Fracture 978 Pregnancy Trauma 984 Procedural Sedation 990 Pseudotumor Cerebri 996 Psychosis Acute 1002 Seizure [books.google.com]

  Synonym: cerebral abscess ; intracranial abscess Symptoms Symptoms may include headache, fever, vomiting, malaise, irritability, seizures, or paralysis. Treatment The usual treatment is chemotherapy. [medical-dictionary.thefreedictionary.com]

WORKUP/INVESTIGATIONS • MRI – IOC • PERINEAL & ANAL USG- also useful • CBC may show leukocytosis • Pus cultures • Blood cultures 7. CLASSIFICATION OF ANORECTAL ABSCESS 1. Perianal (60%) 2. Ischorectal (30%) 3. Submucous 4. Pelvirectal 5. [slideshare.net]

[…] actinomycosis; Chagas’ disease • Cancerous lesions • Chronic anal fistula • Rectovaginal fistula • Proctitis-often STD-associated, including: Syphilis Gonococcal Chlamydia Chancroid Condylomata acuminata • AIDS-associated: Kaposi’s sarcoma Lymphoma CMV WORKUP [encyclopedia.lubopitko-bg.com]

Delaying I&D while treating with antibiotics is inappropriate and may lead to a larger abscess that involves more of the sphincter complex and, in extreme circumstances, to necrotizing infection [3, 8, 13]. 4.3 Workup and Treatment of Abscesses 4.3.1 [abdominalkey.com]

• Staphylococcus Aureus

  Staphylococcus aureus, e.g., methicillin-resistant S. aureus (MRSA), is a common cause. The abscess is surrounded by a membrane of variable strength created by macrophages, fibrin, and granulation tissue. [medical-dictionary.thefreedictionary.com]

  Predominant aerobic bacteria: • Staphylococcus aureus • Streptococcus spp. • Escherichia coli DIAGNOSIS Many patients will have predisposing underlying conditions including: • Malignancy or leukemia • Immune deficiency • Diabetes mellitus • Recent surgery [encyclopedia.lubopitko-bg.com]

  However, in recent years, there has been an increasing number of cases associated with methicillin-resistant Staphylococcus aureus (MRSA), a difficult-to-treat bacterial strain that can be passed through skin-to-skin contact. [verywellhealth.com]

  Proteus  Streptococcus  Staphylococcus aureus  Fistula is more likely if pus culture reveals bowel organisms rather than skin organisms 6. Classification  Perianal  Submucosal  Ischiorectal  Pelvirectal(supralevator)  Fissure abscess 7. [slideshare.net]

• Leukocytosis

  WORKUP/INVESTIGATIONS • MRI – IOC • PERINEAL & ANAL USG- also useful • CBC may show leukocytosis • Pus cultures • Blood cultures 7. CLASSIFICATION OF ANORECTAL ABSCESS 1. Perianal (60%) 2. Ischorectal (30%) 3. Submucous 4. Pelvirectal 5. [slideshare.net]

  Laboratory evaluation may reveal leukocytosis. Patients who suffer from Crohn disease are at increased risk. The diagnosis is made based on the history and a compatible physical examination. [visualdx.com]

  […] site of maximal swelling Pus drained & cultured Fossa probed w/finger or hemostat to disrupt loculations and facilitate drainage Placement of drain only indicated for management of complex or bilateral abscesses Broad spectrum antibiotics if Fever, leukocytosis [fprmed.com]

  His lab work is unremarkable with the exception of a leukocytosis to 15. [accesssurgery.mhmedical.com]

  Injuries above the peritoneal reflection can result in intraperitoneal perforation, with fever, leukocytosis, abdominal pain, and peritonitis. [ahcmedia.com]

Perianal and Perirectal Abscesses (Treatment) should revert to the most conservative approach possible. [tripdatabase.com]

Treatment  Seton is a non absorbable suture (e.g. silk) or tape that is passed across the fistula and tied 25. Treatment  Anal fistula plug repair  Glue injection 26. Treatment  Video assisted anal fistula track ligation 27. [slideshare.net]

However, for patients where physical examination does not reveal an obvious abscess, endoanal ultrasound (EUS) can be used as an adjunct in the office setting. 4.3.1.4 Treatment The treatment of perianal abscesses is incision and drainage. [abdominalkey.com]

Different treatment modalities have been evaluated in more than 400 reported trials. [emedicine.medscape.com]

PROGNOSIS Drainage alone results in cure for 50%. 50% will have recurrences and develop an anal fistula. [slideshare.net]

Associations Recognized associations include: diabetes mellitus Crohn disease pelvic infection trauma anorectal cancer/anal cancer +/- radiation therapy Treatment and prognosis While some abscesses may resolve spontaneously via internal drainage into [radiopaedia.org]

Prognosis The outcome is good if the abscess is treated promptly. One study found that 31% of patients who had incision and drainage of perianal abscess developed a fistula. [patient.info]

Placement of a drain is indicated only for the management (...) and etiology of the lesion. Failure to take the primary etiology into account in the management of a supralevator abscess may lead to iatrogenic fistula formation. [tripdatabase.com]

Presentation outline • Case presentation • Introduction & Etiology • Classification • Clinical features • Investigations • Treatment 7/6/2017 2 3. Case • 28 yrs. [slideshare.net]

Pediatric Considerations Common in 1st year of life Epidemiology Predominant age: all ages (most common in 3rd and 4th decades and during infancy) Predominant sex: male > female (2 to 3:1) Incidence Common Etiology and Pathophysiology Bacterial invasion [unboundmedicine.com]

Perirectal Abscess Pathophysiology Occur in any potential space near the anus or rectum Perianal abscess Adjacent to anus Ischiorectal Few cm away from anus Due to obstruction of anal gland or crypt Etiology Polymicrobial Diagnosis Swelling, erythema, [fprmed.com]

Epidemiology References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified. Etiology Classification Anal abscesses and fistulae may be classified according to their variations in anatomical position and distribution. [amboss.com]

Epidemiology More common in men III. [tripdatabase.com]

Pediatric Considerations Common in 1st year of life Epidemiology Predominant age: all ages (most common in 3rd and 4th decades and during infancy) Predominant sex: male > female (2 to 3:1) Incidence Common Etiology and Pathophysiology Bacterial invasion [unboundmedicine.com]

Although failure of patients to seek medical attention and misattribution of anorectal pain to hemorrhoids confound epidemiological data, an estimated 100,000 cases of anorectal abscess are diagnosed yearly in the United States.1 Most patients present [accesssurgery.mhmedical.com]

Epidemiology, pathophysiology, and classification of fecal incontinence: State of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol. 2015;110:127-136. [crohnsdisease.com]

[…] and Etiology The pathophysiology and etiology of anorectal abscess and fistula-in-ano have not yet been fully defined. [tripdatabase.com]

PATHOPHYSIOLOGY Originates from an infection arising in the crypto glandular epithelium lining the anal canal The internal anal sphincter normally serves as a barrier to infection passing from the gut lumen to the deep perirectal tissues. [slideshare.net]

In this article, we shall look at the pathophysiology, clinical features and management of an anorectal abscess Pathophysiology Anorectal abscesses are thought to be caused by the plugging of the anal ducts. [teachmesurgery.com]

The pathophysiological basis of surgical diseases is discussed in relation to their management, acting as a bridge between basic medical sciences and clinical problems. [books.google.com]

Pediatric Considerations Common in 1st year of life Epidemiology Predominant age: all ages (most common in 3rd and 4th decades and during infancy) Predominant sex: male > female (2 to 3:1) Incidence Common Etiology and Pathophysiology Bacterial invasion [unboundmedicine.com]

Prevention or prompt treatment of STDs may prevent an anorectal abscess from forming. [pennmedicine.org]

[…] or prompt treatment of STDs may prevent an anorectal abscess from forming. [medlineplus.gov]

Some people may be advised to wear a gauze pad or mini-pad to prevent the drainage from soiling their clothes. [webmd.com]

The abscess is opened to allow drainage, and a small mushroom catheter is sutured in situ to assist drainage and prevent premature wound closure. [emedicine.medscape.com]