We present a 52 year old diabetic patient who presented initially with perianal abscess. After a week he presented with abdominal wall cellulitis which soon progressed to an abscess which involved the entire abdominal wall circumferentially. [ijsurgery.com]

PRESENTATION OF CASE A previously healthy sixty-five year old man presented emergently with rectal pain, weight loss and recurrent severe tension headaches. [ncbi.nlm.nih.gov]

• Fever

  High pelvirectal abscesses may cause lower abdominal pain and fever without rectal symptoms. Sometimes fever is the only symptom. [msdmanuals.com]

  Symptoms are severe throbbing pain near the anus with swelling and fever; it may cause an anal fistula. Pus is drained from the abscess by surgical incision. [oxfordreference.com]

  Release of pus Constipation Pain during bowel movements Fever bleeding When the abscess is superficial the person can actually feel the lump of swollen mass near the anus. [hegdehospital.com]

  However, if you experience excessive rectal bleeding, fever, chills, or vomiting after returning home from the procedure, call your doctor immediately. [verywellhealth.com]

  Symptoms are severe throbbing pain near the anus with swelling and fever; it may cause an anal fistula. Pus is drained from the abscess by surgical incision. A Dictionary of Nursing [encyclopedia.com]

• Malaise

  Fever and malaise are common. There may be associated pain on defecation. On examination, which should include a digital rectal examination, there may be a palpable area of fluctuance. There may also be overlying cellulitis. [visualdx.com]

  […] away from anus Due to obstruction of anal gland or crypt Etiology Polymicrobial Diagnosis Swelling, erythema, & flatulence Tender perianal or rectal mass Pain worse with defecation, sitting, walking Continuous throbbing perianal pain May have fever, malaise [fprmed.com]

  Systemic symptoms such as fever and malaise are common. With spontaneous opening, purulent rectal drainage may be seen. On physical ... [accesssurgery.mhmedical.com]

  Deeper abscesses may be less painful but cause toxic symptoms (eg, fever, chills, malaise). There may be no perianal findings, but digital rectal examination may reveal a tender, fluctuant swelling of the rectal wall. [msdmanuals.com]

  Severe abscesses may present with systemic features* such as fever, rigors, general malaise or sepsis. On examination, an abscess will be red and tender and may be discharging purulent or haemorrhagic fluid. [teachmesurgery.com]

• Fatigue

  It causes extreme pain, fatigue, rectal discharge, and fever. In some cases, anal abscesses can result in painful anal fistulas. This occurs when the abscess doesn’t heal and breaks open on the surface of the skin. [healthline.com]

  As the pus starts to consolidate and form a palpable mass, other symptoms of an anorectal abscess appear, including: Fever Fatigue Constipation Rectal discharge and bleeding Feeling like you need to go to the bathroom when you don’t Increasing and [verywellhealth.com]

  Other symptoms may include: Constipation Discharge of pus from the rectum Fatigue, fever, night sweats, and chills Redness, painful and hardened tissue in the area of the anus Tenderness In infants, the abscess often appears as a swollen, red, tender [medlineplus.gov]

  Fatigue : A specially seen in cases with bigger abscesses. Pain in abdomen : There is pain and discomfort in the lower abdomen in some cases. [proctocure.com]

• Recurrent Infection

  On clinical continuum with anorectal fistula, chronic or recurrent infection predisposes to fistula formation. [unboundmedicine.com]

  Recurrent infections may be incised and drained in the emergency department; however, surgical referral should be provided for definitive treatment with removal of the sinus tract and cyst. [ahcmedia.com]

• Pertussis

  Parkinson Disease 802 Munchausen Syndrome 804 Myocardial Contusion 810 Neck Injury by StrangulationHanging 818 Penile Shaft Fracture 820 Sting 822 Necrotizing Soft Tissue Infections 824 Neonatal Jaundice 830 Peripheral Neuropathy 836 Rectal Prolapse 840 Pertussis [books.google.com]

• Pleural Effusion

  286 888 Pregnancy Trauma 898 Foreign Body Esophageal 902 Procedural Sedation 904 Pseudotumor Cerebri 910 Pulmonary Contusion 920 Purpura 926 Peritonsillar Abscess 928 Phalangeal Injuries Hand 934 Phenytoin Poisoning 940 Pityriasis Rosea 946 Red 948 Pleural [books.google.com]

• Constipation

  Constipation or tenesmus may be present in patients that have significant pain with a bowel movement. [statpearls.com]

  You can get tears in the skin if you are constipated. Being constipated means it is hard for you to have a BM. Pushing too hard can cause the tissue in the rectum to tear. [drugs.com]

  […] disease Chronic granulomatous disease (especially Crohn disease) Immunodeficiency disorders Hematologic malignancies (5–8% have anorectal abscess at some time) Diabetes mellitus Chronic medical immunosuppression Morbid obesity General Prevention Avoid constipation [unboundmedicine.com]

  As the pus starts to consolidate and form a palpable mass, other symptoms of an anorectal abscess appear, including: Fever Fatigue Constipation Rectal discharge and bleeding Feeling like you need to go to the bathroom when you don’t Increasing and [verywellhealth.com]

  His previous medical history included chronic constipation and intermittent urinary retention over the preceding five years. [ncbi.nlm.nih.gov]

• Diarrhea

  Anal glands may become infected after a bout of diarrhea, but often we don’t know why it happens. [pezimclinic.com]

  After sufficient supply of fluids, his creatinine level was normalized but he experienced a high fever (38-39℃) and diarrhea on the 4th day of hospitalization. [ncbi.nlm.nih.gov]

  swelling, or redness Pus draining from the abscess Fever of 100.4ºF (38ºC) or higher that continues for a day after starting antibiotics, or as directed by your healthcare provider Other symptoms such as rectal bleeding, abdominal pain, or chronic diarrhea [fairview.org]

• Abdominal Pain

  System(s) affected: gastrointestinal, skin/exocrine Synonym: perianal abscess; perirectal abscess Geriatric Considerations A high pelvirectal abscess may cause minimal symptoms (lower abdominal pain and fever). [unboundmedicine.com]

  High pelvirectal abscesses may cause lower abdominal pain and fever without rectal symptoms. Sometimes fever is the only symptom. [msdmanuals.com]

  or as directed by your healthcare provider Other symptoms such as rectal bleeding, abdominal pain, or chronic diarrhea. [fairview.org]

  […] in the anal area or buttocks Pus drainage near the anus Fever A lump in the anal area Painful bowel movements Lower abdominal pain Fatigue Swelling in the anal area or buttocks Night sweats When to Seek Medical Care for an Anal Abscess If a person suspects [emedicinehealth.com]

  The patient had acute signs, abdominal pain, and mass lesions accompanying oppressive pain upon rectal examination. [ncbi.nlm.nih.gov]

• Anal or Rectal Pain

  Symptoms of an abscess include anal or rectal pain, itching, swelling, and fever. Frequently the abscess results in a fistula, which is an abnormal connection between the abscess and the skin where pus drains. [fairview.org]

  An anorectal abscess (also referred to as an anal abscess, rectal abscess, perianal abscess, or perirectal abscess depending on its location) is a pus-filled cavity that forms within the furrows of the anal canal (called the anal sinuses). [verywellhealth.com]

  For patient education resources, see the Esophagus, Stomach, and Intestine Center and the Digestive Disorders Center, as well as Anal Abscess, Rectal Pain, and Rectal Bleeding. [emedicine.medscape.com]

• Jaundice

  Poisoning 792 Pancreatic Trauma 794 Multiple Myeloma 798 Parkinson Disease 802 Munchausen Syndrome 804 Myocardial Contusion 810 Neck Injury by StrangulationHanging 818 Penile Shaft Fracture 820 Sting 822 Necrotizing Soft Tissue Infections 824 Neonatal Jaundice [books.google.com]

• Prolapse

  Synthetic meshes have been used extensively to augment surgical management of pelvic organ prolapses. Posterior intravaginal sling (IVS) is a technique used for correcting vaginal vault/apical prolapse, posterior vaginal prolapse or rectocele. [ncbi.nlm.nih.gov]

  K622 항문관의 탈출 Prolapse of anal canal K623 직장탈출 Rectal prolapse K623 직장점막의 탈출 Prolapse of rectal mucosa K624 항문 및 직장의 협착 Stenosis of anus and rectum K624 항문(괄약근)의 협착 Stricture of anus (sphincter) K625 항문 및 직장의 출혈 Hemorrhage of anus and rectum [druginfo.co.kr]

  (Medical Encyclopedia) Rectal prolapse repair (Medical Encyclopedia) [ Read More ] [icdlist.com]

  Children who present with rectal prolapse should be referred for cystic fibrosis testing. Rectal prolapse in elderly adults often presents in elderly women and may be associated with uterine prolapse or cystocele. [ahcmedia.com]

  K62.3 직장탈출 Rectal prolapse K62.4 항문 및 직장의 협착 Stenosis of anus and rectum K62.5 항문 및 직장의 출혈 Haemorrhage of anus and rectum K62.6 항문 및 직장의 궤양 Ulcer of anus and rectum K62.7 방사선직장염 Radiation proctitis K62.8 항문 및 직장의 기타 명시된 질환 Other specified diseases of [012hangle012.blogspot.com]

• Fracture

  Methemoglobinemia 786 Hypercalcemia 790 Monoamine Oxidase Inhibitor Poisoning 792 Pancreatic Trauma 794 Multiple Myeloma 798 Parkinson Disease 802 Munchausen Syndrome 804 Myocardial Contusion 810 Neck Injury by StrangulationHanging 818 Penile Shaft Fracture [books.google.com]

  Pre-operative Post-operative 1 0 - Days 14 - Days 3 7 - Days 7 - Days 4 7 - Days 14 - Days 6 14 - Days 14 - Days 14 30 - Days 14 - Days 15 0 - Days 7 - Days 6.9.7 The section on multiple procedures does not apply where the lesser or secondary procedure is: a fracture [albertadoctors.org]

  The CT imaging, useful for investigating the possibility of occult femoral neck fracture, was fortuitous in leading to the diagnosis. One must consider the possibility of visceral processes causing referred pain (...) [tripdatabase.com]

  It is seldom primary but usually occurs secondary to infections of the middle ear, nasal sinuses, face, or skull or from contamination from penetrating wounds or skull fractures. [medical-dictionary.thefreedictionary.com]

• Contusion

  Mastitis 672 Measles 678 Smoke Inhalation 680 Urinary Retention 1172 Meniere Disease 686 Meningitis 688 Snake Envenomation 694 Mononucleosis 708 Multiple Sclerosis 714 Myasthenia Gravis 722 Myocardial Contusion 724 Myocarditis 726 Neuroleptic Malignant [books.google.com]

• Seizure

  Cerebral 960 Pneumothorax 962 Poisoning Gastric Decontamination 968 Dysfunctional Uterine Bleeding 336 Retropharyngeal Abscess 970 Polycythemia 974 Rib Fracture 978 Pregnancy Trauma 984 Procedural Sedation 990 Pseudotumor Cerebri 996 Psychosis Acute 1002 Seizure [books.google.com]

  Synonym: cerebral abscess ; intracranial abscess Symptoms Symptoms may include headache, fever, vomiting, malaise, irritability, seizures, or paralysis. Treatment The usual treatment is chemotherapy. [medical-dictionary.thefreedictionary.com]

• Giddiness

  Sever pain, inability to pass stool, high grade fever, dizziness, giddiness, persistence vomiting are emergency signs, when the patients should immediately seek medical advice. [proctocure.com]

• Vertigo

  Streptococcal Disease 1156 Tuberculosis 1158 Tympanic Membrane Perforation 1164 Suicide Risk Evaluation 1166 Gastritis 1168 Syncope 1172 Ovarian CystTorsion 788 1195 Ventilator Management 1198 Ventricular Peritoneal Shunts 1202 Urinary Tract Fistula 1174 Vertigo [books.google.com]

• Spinal Cord Syndrome

  Cord Syndromes 1042 Coccyx 1048 Splenic Injury 1054 Subarachnoid Hemorrhage 1076 Vomiting Pediatric 1220 1082 Pleural Effusion 866 1096 Fibrocystic Breast Disease 410 TemporalMandibular Joint InjurySyndrome 1102 Reiter Disease 950 1116 Gonococcal Disease [books.google.com]

• Incontinence

  A 50-year-old woman was referred for evaluation with an 8-month history of intermittent malodorous vaginal discharge initially noted 2 months after placement of a transobturator tape for stress urinary incontinence. [ncbi.nlm.nih.gov]

  Rechberger T, Rzezniczuk K, Skorupski P, Adamiak A, Tomaszewski J, Baranowski W, Jakowicki JA (2003) A randomized comparison between monofilament and multifilament tapes for stress incontinence surgery. [link.springer.com]

  Faecal incontinence Incontinence ranges from being unable to control flatus (wind) through to complete incontinence of flatus and stool. Incontinence is rare and every effort is made to prevent it. [denzilmay.com]

  References: [1] [5] [3] Treatment Fistulae Postoperative complications Painful defecation Fecal incontinence Urinary retention References: [4] [1] [6] [5] [7] [amboss.com]

  WHAT IS FECAL INCONTINENCE? Fecal incontinence (also called anal or bowel incontinence) is the impaired ability to control the passage of gas or stool. This is a common problem, but often not discussed due to embarrassment. [fascrs.org]

• Renal Injury

  Hand 934 Phenytoin Poisoning 940 Pityriasis Rosea 946 Red 948 Pleural Effusion 952 Renal Injury 956 Reperfusion Therapy Cerebral 960 Pneumothorax 962 Poisoning Gastric Decontamination 968 Dysfunctional Uterine Bleeding 336 Retropharyngeal Abscess 970 [books.google.com]

WORKUP/INVESTIGATIONS • MRI – IOC • PERINEAL & ANAL USG- also useful • CBC may show leukocytosis • Pus cultures • Blood cultures 7. CLASSIFICATION OF ANORECTAL ABSCESS 1. Perianal (60%) 2. Ischorectal (30%) 3. Submucous 4. Pelvirectal 5. [slideshare.net]

[…] actinomycosis; Chagas’ disease • Cancerous lesions • Chronic anal fistula • Rectovaginal fistula • Proctitis-often STD-associated, including: Syphilis Gonococcal Chlamydia Chancroid Condylomata acuminata • AIDS-associated: Kaposi’s sarcoma Lymphoma CMV WORKUP [encyclopedia.lubopitko-bg.com]

Delaying I&D while treating with antibiotics is inappropriate and may lead to a larger abscess that involves more of the sphincter complex and, in extreme circumstances, to necrotizing infection [3, 8, 13]. 4.3 Workup and Treatment of Abscesses 4.3.1 [abdominalkey.com]

• Pleural Effusion

  286 888 Pregnancy Trauma 898 Foreign Body Esophageal 902 Procedural Sedation 904 Pseudotumor Cerebri 910 Pulmonary Contusion 920 Purpura 926 Peritonsillar Abscess 928 Phalangeal Injuries Hand 934 Phenytoin Poisoning 940 Pityriasis Rosea 946 Red 948 Pleural [books.google.com]

Perianal and Perirectal Abscesses (Treatment) should revert to the most conservative approach possible. [tripdatabase.com]

Treatment  Seton is a non absorbable suture (e.g. silk) or tape that is passed across the fistula and tied 25. Treatment  Anal fistula plug repair  Glue injection 26. Treatment  Video assisted anal fistula track ligation 27. [slideshare.net]

However, for patients where physical examination does not reveal an obvious abscess, endoanal ultrasound (EUS) can be used as an adjunct in the office setting. 4.3.1.4 Treatment The treatment of perianal abscesses is incision and drainage. [abdominalkey.com]

Different treatment modalities have been evaluated in more than 400 reported trials. [emedicine.medscape.com]

PROGNOSIS Drainage alone results in cure for 50%. 50% will have recurrences and develop an anal fistula. [slideshare.net]

Associations Recognized associations include: diabetes mellitus Crohn disease pelvic infection trauma anorectal cancer/anal cancer +/- radiation therapy Treatment and prognosis While some abscesses may resolve spontaneously via internal drainage into [radiopaedia.org]

Prognosis The outcome is good if the abscess is treated promptly. One study found that 31% of patients who had incision and drainage of perianal abscess developed a fistula. [patient.info]

Placement of a drain is indicated only for the management (...) and etiology of the lesion. Failure to take the primary etiology into account in the management of a supralevator abscess may lead to iatrogenic fistula formation. [tripdatabase.com]

Presentation outline • Case presentation • Introduction & Etiology • Classification • Clinical features • Investigations • Treatment 7/6/2017 2 3. Case • 28 yrs. [slideshare.net]

Pediatric Considerations Common in 1st year of life Epidemiology Predominant age: all ages (most common in 3rd and 4th decades and during infancy) Predominant sex: male > female (2 to 3:1) Incidence Common Etiology and Pathophysiology Bacterial invasion [unboundmedicine.com]

Perirectal Abscess Pathophysiology Occur in any potential space near the anus or rectum Perianal abscess Adjacent to anus Ischiorectal Few cm away from anus Due to obstruction of anal gland or crypt Etiology Polymicrobial Diagnosis Swelling, erythema, [fprmed.com]

Epidemiology References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified. Etiology Classification Anal abscesses and fistulae may be classified according to their variations in anatomical position and distribution. [amboss.com]

Epidemiology More common in men III. [tripdatabase.com]

Pediatric Considerations Common in 1st year of life Epidemiology Predominant age: all ages (most common in 3rd and 4th decades and during infancy) Predominant sex: male > female (2 to 3:1) Incidence Common Etiology and Pathophysiology Bacterial invasion [unboundmedicine.com]

Although failure of patients to seek medical attention and misattribution of anorectal pain to hemorrhoids confound epidemiological data, an estimated 100,000 cases of anorectal abscess are diagnosed yearly in the United States.1 Most patients present [accesssurgery.mhmedical.com]

Epidemiology, pathophysiology, and classification of fecal incontinence: State of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol. 2015;110:127-136. [crohnsdisease.com]

[…] and Etiology The pathophysiology and etiology of anorectal abscess and fistula-in-ano have not yet been fully defined. [tripdatabase.com]

PATHOPHYSIOLOGY Originates from an infection arising in the crypto glandular epithelium lining the anal canal The internal anal sphincter normally serves as a barrier to infection passing from the gut lumen to the deep perirectal tissues. [slideshare.net]

In this article, we shall look at the pathophysiology, clinical features and management of an anorectal abscess Pathophysiology Anorectal abscesses are thought to be caused by the plugging of the anal ducts. [teachmesurgery.com]

The pathophysiological basis of surgical diseases is discussed in relation to their management, acting as a bridge between basic medical sciences and clinical problems. [books.google.com]

Pediatric Considerations Common in 1st year of life Epidemiology Predominant age: all ages (most common in 3rd and 4th decades and during infancy) Predominant sex: male > female (2 to 3:1) Incidence Common Etiology and Pathophysiology Bacterial invasion [unboundmedicine.com]

Prevention or prompt treatment of STDs may prevent an anorectal abscess from forming. [pennmedicine.org]

[…] or prompt treatment of STDs may prevent an anorectal abscess from forming. [medlineplus.gov]

Some people may be advised to wear a gauze pad or mini-pad to prevent the drainage from soiling their clothes. [webmd.com]

The abscess is opened to allow drainage, and a small mushroom catheter is sutured in situ to assist drainage and prevent premature wound closure. [emedicine.medscape.com]