What Is a Perianal Abscess?

Perianal abscess, also known as anal rectal abscess, is called anal condyle by Chinese medicine. Perianal abscess is an acute purulent infectious disease that occurs around the anus, anal canal, and rectum. It is a bacterial infection and is the precursor of anal fistula. This disease and anal fistula are one of the three major diseases of the anorectal, with an incidence of about 2%, accounting for 8% to 25% of anorectal diseases. It is more common in men aged 20 to 40. The incidence of men is three to four times that of women, and the incidence of pediatrics is relatively high.

Basic Information

nickname: Anal rectal abscess
TCM disease name: Anal
Visiting department: Anorectal, general surgery
Multiple groups: 20 to 40 year old men

Common locations: Around the anus, anal canal and rectum
Common causes: Intestinal bacteria enter the anal sinus, causing anal gland infection and spreading to the perianal space
Common symptoms: Persistent severe perianal pain is gradually increasing
Contagious: no

Causes of perianal abscess

This disease belongs to the bacterial infection in the intestine. The "intestinal bacteria" is the source and the factor causing the disease. The "anal sinus" is the entrance to the infection, and it is also the inside mouth after abscesses and fistulas. The "anal gland" is the route of infection. It first infects and then spreads. "Perianal space" is the ultimate site of disease. Intestinal bacteria enter the anal sinus and cause inflammation, blocking the opening of the anal gland, causing anal gland fluid to flow out, causing anal gland infection. The infection spreads through the muscle space and lymphatic vessels to the perianal space, and finally forms anorectal abscess.

Clinical manifestations of perianal abscess

The main symptom of perianal abscess is pain. This pain can be very severe and gradually worsen. Many patients say they can't eat and can't sleep. After the abscess ulcerated on its own, the pain temporarily eased.

Low abscesses show severe anal pain, and the pain persists. A rectal abscess (high position) is not necessarily painful. Because the rectum belongs to the pelvic cavity, the vegetative nerves distributed here are not sensitive to ordinary stimuli, and the main manifestations are local swelling and a sense of constipation.

Another symptom of perianal abscess is fever, which can exceed 40 ° C. In general, the larger and deeper the pus cavity, the greater the probability of fever. Some patients also experience poor stool, poor appetite, and insomnia.

Perianal abscess classification

Perianal subcutaneous abscess

It is the most superficial abscess, which is distributed under the skin of the anal margin, mostly on the posterior and lateral sides. The infection route is the skin of the anal sinus and anal margin. The lesions are more localized and rarely spread to the surroundings. The inner mouth is at the position of the tooth line corresponding to the lesion. Localized swelling and pain, but fever is rare.

2. Perineal subfascial abscess

Located on the front side of the anus, it is mainly male and extends all the way to the root of the scrotum. The abscess in this area is divided into two layers. The route of infection is the anal sinus at the anterior tooth line and the skin of the anal canal, so the inner mouth is generally located here. If the disease is not treated in time, it usually spreads to the scrotum. Clinical manifestations are the same as subcutaneous abscesses.

3. Posterior anal canal abscess

It is located at the back of the anus and is divided into two layers, the shallow layer and the perianal subcutaneous space. Deep to the ischiocoral fossa on both sides. The route of infection is the posterior anal sinus and posterior anal fissure at the tooth line. The inner mouth is mostly at the rear midline tooth line position. Easy to spread to both sides after the onset. The pain is obvious, fever or no fever, and local redness and swelling are obvious.

4. Sciatic rectal fossa abscess

This is the largest abscess around the anus, one on each side, and communicates through the deep space behind the anal canal. The infection is basically anal sinus. There are two possibilities for the position of the inner mouth, one is the position corresponding to the lesion, and the other is the posterior center. One side abscess will spread to the opposite side, forming a horseshoe or half-horse-shaped abscess. Most complex anal fistulas originate from abscesses in this area. The swelling and heat pain were all obvious. The patient was restless, had a poor diet, and was very distressed.

5. Sphincter space abscess

Between the internal and external sphincter, is the primary site of many perianal infections. As mentioned earlier, the anus sinus is the most important entrance for bacteria to invade the anus, but the anus glands are actually entered into the anus, and most of the anal glands are located between the sphincter muscles. Bacteria often infect here and then spread to other spaces. The inner mouth has no definite location, but in the future, the median tooth line position will be more, and the direction of spread is also uncertain. The pain is obvious, the early redness is not obvious, the anus can be relaxed, and the tenderness is extensive.

6. Rectal submucosal abscess

The submucosa of the lower rectum is located on the front, back, left, and right. It is a high abscess. The bacterial invasion is the anal sinus. The lesions are limited and rarely spread to the surroundings. The inner mouth and the lesions are in the same location. Fever is rare, and the main manifestations are bloating and constipation. Digital diagnosis can touch the soft bulge at the lower end of the rectum.

7. Posterior rectal space abscess

Located on the back of the rectum, it is the highest of all abscesses. The bacterial infection is the anal sinus, and the inner mouth is at the posterior median tooth line. After the onset, it may spread to the pelvic rectal space on both sides, forming high horseshoe abscesses and anal fistulas, which is difficult to treat clinically. Pain was significant or not, bloating, feeling of constipation, fever, harder bumps on the back of the rectum, scarring of straight anal ring.

8. Pelvic rectal fossa abscess

It is located on both sides of the lower rectum, one on the left, one on the left, one above the pelvic floor, one below the peritoneum, and one below the corresponding sciatic rectal space, which is a high abscess. The infection is through the anal sinus, and the inner mouth is mostly located in the posterior median tooth line. After the disease, it may spread to the contralateral side through the posterior rectal space, or it may spread down to the sciatic rectal space. The performance is the same as a postrectal abscess, which can touch harder bulges on both sides of the lower rectum.

Five check

1. Anorectal examination

Look: Look at the swelling range, see if there is mucus out at the tooth line, and judge the position of the inner mouth.

Touch: Digital diagnosis is very important, whether it is low or high, digital diagnosis is sometimes more accurate than B-ultrasound.

2. Blood routine test

The blood test can determine the severity of the abscess.

3.B-ultrasound

B ultrasound has been widely used in the diagnosis of anal fistula and perianal abscess. An experienced examiner can accurately describe the direction of the pus cavity and fistula, the relationship with the sphincter, and the position of the inner mouth.

4.CT and magnetic resonance examination

It is mainly used for invisible high abscesses.

Differential diagnosis of perianal abscess

The perineal subfascial abscess should be distinguished from necrotizing fasciitis.

Necrotizing fasciitis is a clinically rare, but very high mortality, necrotizing soft tissue infection caused by a variety of bacterial infections. It is a kind of necrosis caused by the embolism of subcutaneous blood vessels due to infection, and affects local The ability of resistance to aggravate the infection causes a vicious circle, which causes the infection and necrosis to spread rapidly along the fascia and cause a large-scale, rapid necrosis of the soft tissue. If it is not diagnosed and treated properly, it can cause toxemia, sepsis and infection. Toxic shock.

The patient had an acute onset, all had fever, a significant increase in the number of white blood cells, flaky black lesions in the perianal area and perineum, and conjugation of sounds under the skin. Progressive necrosis of large areas of skin and fascia affected the scrotum and labia majora. It reaches the lower rectum, lower abdomen, and back waist. It has a wide area and spreads quickly. Some cases also include diabetes, hypoalbuminemia, toxemia, sepsis, toxic shock, and diabetes insipidus.

Perianal abscess treatment

There are not many options for the treatment of this disease. The cure is only surgery, and the sooner the better. Medication can be chosen in cases where surgery is unconditional or physical conditions do not allow it.

Drug treatment

(1) Oral antibiotics can be selected for anti-inflammatory superficial abscesses, and broad-spectrum antibiotics are generally used. For a relatively large range of abscesses, a combination of drugs such as metronidazole, etimicin sulfate, kanamycin, and streptomycin is required.

(2) Apply golden cream, Huoxuezhitongsan, Sihuang cream, Yulu cream, etc. for external use .

(3) In the "Summary of Surgery", which has been taken by Xue Ming, a Chinese medicine orally , the treatment concept of dissipating from the beginning and the treatment of poisoning in the pus stage is proposed. You can use Xianfang Live Life Drink, Huanglian Jiedu Decoction.

2. Surgical treatment

(1) Pump the pus and decompress it for local disinfection. Use a 20ml syringe to pierce the pus cavity from the weakest part of the abscess, extract the pus, and move the needle up and down while pumping until no pus can be pumped.

This method can temporarily reduce the tension of the pus cavity and relieve pain, and is suitable for temporary emergency treatment, but cannot replace surgery. If the condition develops quickly, such as necrotizing fasciitis, etc., it cannot be used, so as not to delay the condition.

(2) Incision and drainage of the pus Under local anesthesia, a small opening is excised from the middle of the pus cavity, and the pus cavity is rinsed with metronidazole after operation, and an oil gauze strip is placed for drainage.

It is a temporary emergency treatment, or the first operation of secondary surgery. The pus can be discharged and the symptoms can be quickly relieved, but it cannot replace the radical operation. Generally, it takes about 3 months until the fistula is formed, the inner mouth is clear, and then the radical operation is performed.

(3) Radical operation Low abscess-direct incision. Horseshoe abscess-incision and open. high abscess-suture. high abscess-isobaric drainage. Because the anal straight ring was still cut by the cutting and hanging thread, the pain was great and the wound was deep. In order to further reduce the surgical trauma, two-way isobaric drainage surgery can be adopted. During the operation, a half-cut hanging thread and a drainage tube are placed to heal the pus cavity without cutting the anal straight ring.

Perianal abscess prognosis

Early aggressive surgical treatment can cure most anorectal abscesses. The condition of high abscess is complicated, and there may be repeated attacks. Very few patients can be fatal due to infection.

Perianal abscess prevention

There are many reasons for the incidence of anorectal abscesses, but intestinal flora imbalance and decreased immunity are the two root causes. Therefore, prevention of intestinal flora imbalance and improvement of immunity are the basic strategies to prevent perianal abscess. ^[1-4]