Paraproctitis and Anorectal Abscess

Etiology and pathogenesis

Paraproctitis – purulent inflammation of the tissues surrounding the rectum (cellulitis)
The most common cause is penetration of bacterial flora from the rectum to the surrounding tissue
- E.coli, anaerobes, staphylococcus, streptococcus, enterococcus
Usually arises from the cryptoglandular epithelium lining the anal canal – leads to damage of the rectal mucosa
- Infection of the glandular secretions leads to suppurative spread – can form an abscess/fistula
Can result as a complication of Crohn’s disease and ulcerative colitis

Classification

Etiological

Activity of inflammatory process

Localisation of abscess (see pic)

Perianal – superficial collection of purulent material under skin of anal canal
Ischio-rectal – suppuration traverses the external anal sphincter into ischiorectal space
Intersphincteric – suppuration continues between internal and external anal sphincter
Supralevator – upward extension from intersphincteric abscess above levator ani
Submucosal – abscess is under the mucosa, paain and skin changes are less pronounced

Clinical features

Initial presentation – short period of malaise, weakness, headache, fever, chills
Severe pain in perianal region – make it difficult to sit
Tender, smooth, soft swelling in the region
External signs – erythema, induration
Tenesmus, passage of mucus and blood

Investigations

Treatment

Prevention

Complication