Perirectal Abscess

Perirectal Abscess is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

Localized infection and accumulation of purulent material adjacent to anus or rectum

Etiology

  • Anal crypt gland infection, with spread to adjacent areas separated by muscle and fascia:
    • Perianal:
      • Most common
      • Usually with red bulge near anus
    • Ischiorectal:
      • Large potential space
      • May become very large before diagnosed
      • Can communicate posteriorly with other side forming “horseshoe” abscess
    • Intersphincteric:
      • Contained at primary site of origin between internal and external sphincters
    • Supralevator:
      • Very deep above levator ani
      • Needs operative débridement under general anesthesia
      • Often systemic symptoms before diagnosis is made
  • Bacterial cause is typically a mix of stool pathogens:
  • Associated diseases:
    • Diabetes
    • Inflammatory bowel disease
    • Malignancy
    • Immunocompromised host

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Basics

Description

Localized infection and accumulation of purulent material adjacent to anus or rectum

Etiology

  • Anal crypt gland infection, with spread to adjacent areas separated by muscle and fascia:
    • Perianal:
      • Most common
      • Usually with red bulge near anus
    • Ischiorectal:
      • Large potential space
      • May become very large before diagnosed
      • Can communicate posteriorly with other side forming “horseshoe” abscess
    • Intersphincteric:
      • Contained at primary site of origin between internal and external sphincters
    • Supralevator:
      • Very deep above levator ani
      • Needs operative débridement under general anesthesia
      • Often systemic symptoms before diagnosis is made
  • Bacterial cause is typically a mix of stool pathogens:
  • Associated diseases:
    • Diabetes
    • Inflammatory bowel disease
    • Malignancy
    • Immunocompromised host

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