Abscess / Perianal sepsis


Abscess / Perianal sepsis is one of the most commonly observed in anorectal lesions ,leading to abscess formation and often fistula development . It also remains one of the most challenging anorectal conditions to treat, often requiring multiple attempts and different management strategies.

Aetiology

Crypto glandular ( anal crypt),Trauma, Crohn’s disease ,Chronic ulcerative colitis,Foreign body,Carcinoma ( anal /rectal),Tuberculosis and others.

Clinical presentation

Acute perianal sepsistypically presents with new onset of pain and swelling in the affected area . The pain is aggravated by movement and defecation and sometimes even coughing or sneezing .

Pain present with general malaise and fever.

A clinical history may also reveal an originator bout of diarrhea.

In the intersphincteric abscess the pain can often persist undiagnosed .Pain remains day and night , and cause extreme pain on defecation to the point of causing secondary faecal impaction.

Occasionally , minor anal bleeding and or purulent discharge may observed.

Chronic perianal sepsis often having history of pain followed by spontaneous purulent discharge and subsequently temporary relief. When drainage is incomplete, the abscess cavity may accumulate and the internal opening may bleed from chronic granulation tissue.

However when pain is present in anal region further investigations are important like MRI .

Treatment

Although perianal sepsis are difficult to treat but it can manage after proper diagnosis by Antibiotics, Incision & drainage,Ksharkarma , IFTAK (Interception of Fistula Tract and Ksharsutra application)

When it is with fistula in ano then Ksharsutra is choice of treatment.