Anorectal Abscess

Anorectal abscess frequently results from a cryptoglandu-lar infection. Extension may lead to perianal, ischiorectal, intersphincteric, or supralevator abscess. A horseshoe abscess originates from the deep postanal space communicating to the right and left ischiorectal spaces.

The treatment of an anorectal abscess is incision and drainage. With the exception of simple perianal and ischiorectal abscesses, the surgery is performed in the operating room under adequate anesthesia. A cruciate incision is made and the edges of the skin are excised to allow adequate drainage. A horseshoe abscess is drained through an incision made between the coccyx and the anus, exposing the deep postanal space. An opening made in the posterior midline and the lower part of the internal sphincter is divided to eradicate the source of the infected gland. Counter incisions are made over each ischiorectal fossa to allow drainage of the anterior extensions of abscess (Figure 91-1).

An intersphincteric abscess usually requires evaluation under anesthesia for the diagnosis. Treatment involves unroofing of the abscess cavity by partially dividing the internal sphincter along the length of the abscess cavity. A supralevator abscess most often results from a pelvic abscess, but can also result from an upward extension of an inter-sphincteric or ischiorectal abscess. It is important to determine the source of the abscess, as the surgical approach differs in each case. If the origin is an intersphincteric abscess, it is drained through the rectum in order to avoid a suprasphincteric fistula, as would occur through the ischiorectal fossa. In contrast, if the cause is an upward extension of an ischiorectal abscess, drainage should be through the ischiorectal fossa. Finally, if the abscess originates from the pelvis, drainage can be achieved either through the rectal lumen or by laparotomy. It is our practice not to perform a fistulotomy during drainage due to the risk of incontinence as the tissue planes are inflamed and distorted, precluding accurate assessment of sphincter involvement.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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