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perirectal abscess
Etiology:
risk factors
1) diabetes
2) inflammatory bowel disease
3) immunocompromised patients
Clinical manifestations:
- painful induration in perianal area
- erythematous, palpable mass, with drainage
- fever
- may or may not worsen with bowel movements
Differential diagnosis:
- anal fissures
- pain worsens with bowel movements
- may be visible as a small tear in the anus distal to the dentate line
- thrombosed hemorrhoid
- persistent rectal or perianal pain
- may worsen with bowel movements
- hard, purple lump at the anal verge
- no purulent drainage
- fever uncommon
- pilonidal abscess
- occur in the gluteal cleft above the anus, near the coccyx
- hydradenitis suppurativa
- intertriginoud areas such as axilla, groin, perianal area, inframammary region
- comedones, sinus tracts, scarring, inflammatory nodules
Management:
1) incision & drainage
2) gram negative antibiotic coverage (except Crohn's disease)
3) see Crohn's disease for treatment of perirectal fistula & & perirectal abscess in oatients with Crohn's disease
General
abscess
anorectal disease
References
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 360
- Whiteford MH, Kilkenny J 3rd, Hyman N, Buie WD, Cohen J,
Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S,
Shellito P, Nelson R, Tjandra JJ, Newstead G; The Standards
Practice Task Force; The American Society of Colon and
Rectal Surgeons.
Practice parameters for the treatment of perianal abscess and
fistula-in-ano (revised).
Dis Colon Rectum. 2005 Jul;48(7):1337-42.
PMID: 15933794
http://www.fascrs.org/associations/1843/files/pp_0705.pdf