Tokushukai Medical Group

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Digestive System Surgery: Perianal Abscess

Perianal Tumor is an inflammation disease developed around the anus. Symptoms like fever, bloating, aching pain or discharge of pus are appeared.

Classification of perianal tumor.

Basically, it is grouped into two categories. They are anal-fistula abscess and non- anal fistula abscess.

Anal fistula Abscess
It will fistulize then becomes anal fistula.
  1. Low Interscalene abscessThis takes approximately 70 % of low intercalate abscess anal fistula abscess. Virus invade from internal opening of fistula, and infect to anal gland of internal and external sphincter, form the small abscess, then inflammation goes below from dentate line to form the abscess around the subcutaneous outer ribs.
  2. High-ranking Interscalene abscessThis takes about 10% of high intercalate abscess whole abscess. Abscess is spread out between sphincter on the above (Deep part) of dentate line.
  3. Sciatic Rectum AbscessAbout 20% of anal fistula abscess of the sciatic rectal fossa is correspond to this. And the most of their internal opening is anus litter at the 6° back of anal.
  4. Pelvic rectal chance AbscessAbscess is advanced to the space which is surrounded by upper part of pelvic rectal chance abscess for anus and sacral bone and Fukuma Woo.
Non-anal Fistula Abscess
Indicate the one which do not involve the infection from anus litter to anal gland.
  1. Subcutaneous or Submucosal abscessAbscess developed, under the skin or under mucosal abscess anal canal subepithelium or under rectum mucosal. There are the one which anal fissure or internal hemorrhoid is infected case, or the one originated by trauma such as blocked blood vessel or foreign object.
  2. Pelvic rectal chance AbscessAbscess formation occurs directly from pelvirectal abscess rectum side through rectum mucosal. Abscess of rectum, diverticulum, endometriosis, foreign object.
  3. Hair Nest FistulaAbscess formation or pus-discharge sinus duct from the backside of pilonidal abscess anal to middle hole split on upper side of coccygeal bone. It can be commonly seen in hairy young male.
  4. Pus Skin DiseaseChronic suppurative skin disease complicated with apocrine gland infection from perianal pyoderma to perineal area. This is common among young male whose apocrine gland is in active period. About half of them may be accompanied with hemorrhoid.
  5. Hemorrhoid cancer
  6. 6. Necrotizing FasciitisWhen perianal abscess is developed, and anaerobic infection is compounded to the patients who has basic disease, such as Necrotizing Fasciitis diabetes, under steroid treatment, immune deficit, death of tissue is widely spread and progressed around perianal to perineum, then if it is left untreated, it becomes septic (blood poisoning) and it is lethalness.
  7. Perianal abscess as blood disease
  8. Other FolliculitisThey are complicated with suppurative atheroma or Crohn disease.

1 High-ranking Interscalene abscess 5 Mucosal and subcutaneous abscess
2 Low Interscalene abscess 6 Pelvic rectal chance Abscess
3 Interscalene and sciatic fossa abscess 7 Sciatic Rectum Abscess
4 Submucosal abscess 8 Subcutaneous abscess

Treatment is basically incision and drainage.

Upon diagnosed by CT, MRI, treatment (incision and drainage) is performed. Incision method is listed as below.

Submucosal abscess
Making puncture or open from under the skin via internal sphincter.
Submucosal abscess, Low Interscalene abscess
Open skin abscess faction part up.
High-ranking Interscalene abscess
Abscess formation is unlikely exist only at high-ranking part, but likely exist continuously in intermuscular to high-rank from deep under skin. Open surgery is made from skin.
Sciatic Rectum Abscess
For the case where abscess covers semi perimeter on both side, open 2 to 3 positions up, or when abscess cavity is large and deeper, insert a drain.
Pelvic rectal chance Abscess
Abscess part is deep, but in many cases, there exist under anus muscle so that open till under anus muscle and perform drainage first, then retain neratondrane at abscess cavity pierced through anus muscle, and cleaning is also performed.