Anal absces : Definition, symptoms, Surgical Treatment and complications

 Definition

Anal abscess definition

An anal abscess is a collection of pus around the anus

The origin of the abscess is an infection which touches one of glands normally present at the high part of the anal channel in the thickness of the muscle sphinctérien.

These glands have an opening towards the interior of the anal channel. It can be blocked and be infected with germs present in the saddles. The reasons of the infection of an anal gland are unknown.

Once the declared infection, an abscess is formed very quickly.

The infection perforates the wall of the rectum by causing the contamination of grease in the neighbourhoods.

A pocket filled with pus will extend under the skin around the more or less fast anus of way.

• Absces anal
• An acute accident which can touch everyone, without particular cause. As much the man that the woman, generally between 30 and 50 years, but also the child and the elderly person. There is no particular cause only one anal abscess in all its life except for the typical case of the disease of Crohn digestive inflammatory disease

There exist other causes of abscess in the anal area, less frequent and without relationship with the infection of an anal gland, they are mainly skin diseases (disease of Verneuil, sebaceous cysts) or the infection of a cyst pilonidal.

Symptoms anal abscess
 

Pain

Tumefaction

Fever

Difficulty of urinating

Constipation

 Diagnosis

The clinical examination anal area finds a tumefaction, red, heat, inflammatory, visible on one of the banks of the anus.

With the touch (palpation), this tumefaction is painful. It can appear hardened, infiltrated, or already fluctuating if the abscess is collected.

If the abscess is deeper, the diagnosis is less easy and could lend to confusion with a tumour

In this case there, the fever and hyperleucocytosis make lean towards the assumption of an abscess.

Examination under general anaesthesia

It is, finally, the examination under general anaesthesia which brings the confirmation of the diagnosis and makes it possible to bring the most precision as for the seat and the exact extent of the collection

Surgical Treatment of anal absces

The opening/evacuation of the abscess is necessary in urgency!

To relieve the pain and to avoid the progression of the infection, the fast opening of the abscess is necessary.

This gesture is possible with a simple local anaesthesia but we prefer the general anaesthesia

The patient is placed in décubitus dorsal, the well folded up legs (position “gynecologist”).

The operation consists of an incision compared to the abscess which one evacuates like all infected fabrics.

One gently breaks down with the finger the partitions to finish evacuating this abscess

One washes with betadine and hydrogen peroxide and one drains by using a wick or a blade of rubber.

One must always search a communication with infected gland (sinus way)

When a communication is found, one must treat it by draining it.

If the drainage of the abscess is of good quality, the antibiotics are not necessary.

It is necessary to avoid the anti-inflammatory drugs which can worsen the abscess

Once opened, the abscess continues to be emptied during a few days, then it is closed gradually.

Complete relief as of the alarm clock.

The bandage is renewed each jou

Sometimes the antibiotics are continued during 5 days.

Paraffin oil associated with lactulose is given each morning to facilitate the transit

(transulose: 1-3 coffee spoons per day)

Local hygiene is very important. The sitzbaths or washings with fresh water are desirable.

The cicatrization is obtained into 10 to 15 days.

Complications anal abscess

• YOUR TITLE
• Repetition: It occurs in an unforeseeable way after a few weeks, month or years. There exists a more or less direct sinus way between the opening of pathological gland in the anal channel (the cryptite) and the cutaneous external opening.
• Anal Fistula:                                                                                                                    It is this sinus way, which one calls also anal dent, that will have to be treated to avoid the repetitions.
• Caused to become gangrenous of Baker (périnéo scrotale causes to become gangrenous): Certain abscesses are sometimes serious from the start and contain germs called anaerobes. These germs develop without needing oxygen, they produce gases and toxins. In this case, fortunately exceptional, the infection progresses very quickly in fabrics around the anus and can extend to the genitals, the belly, the totality of the buttocks.

Caused to become gangrenous of Baker

Périnéo-scrotale causes to become gangrenous (Caused to become gangrenous of baker) is a serious disease.

• Traitment
• Excised surgical early and repeated regularly under general anaesthesias
•  Installation of aspiration Bandage VAC
• Know-pubic catheter
• Installation of a colostomy of discharge

In spite of an energetic therapeutic assumption of responsibility, it remains at the origin of an important mortality rate.

At the fragile subjects (diabetic in particular) the evolution is often mortal in spite of a well led treatment.

This extremely serious evolution in septic Shock (anaerobic, gram –) can very quickly occur (in a few days) either from the start, or starting from an abscess which was not treated.