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A patient who feels ill and complains of fever, chills and pain in the anal area could be suffering from a perianal abscess.
Pain in the perianal area is the most common symptom of an anorectal abscess. Most of the active abscesses present with severe throbbing pain. Occasionally it could be dull aching. It is worst when the person sits on the chair. The pain is worsened during the act of defection. The patient may have constipation, fever and chills, or a palpable tender mass near the anus. The condition can become extremely painful, and usually worsens rapidly over the course of just a few days. The partially ruptured abscess gives rise to the pus discharge from the area, soiling the clothes. Commonly when it ruptures it leads to the significant reduction in pain.
Unruptured abscess left untreated may expand, causing serious systemic infection.
Diagnosis of anorectal abscess begins with a medical history and local physical examination. Imaging studies like pelvic CT scan, MRI or trans-rectal ultrasound aid in the diagnosis of the deep-seated abscess. Although these studies are not always necessary, they are useful in those cases which are not obvious on physical examination.
Surgery is advised to evacuate the pus completely and break the compartments in the abscess cavity. The patient is admitted to the hospital. The surgery is performed in an operating room under anaesthesia. Generally, a portion of the evacuated pus is sent for microbiological analysis to determine the type of infecting bacteria. The cavity is irrigated, cleaned with the antiseptic solutions and copious amount of normal saline. The well-cleaned abscess cavity is packed with a medicated gauze.
The patient experiences an almost complete relief of the severe pain in the immediate postoperative period. Operative pain of the incision is mild in comparison. At the next dressing, the pack in the cavity is exchanged with the smaller sized one. With each progressive dressing, the abscess cavity obliterates very fast.
Sitz bath in postoperative period gives a comfortable feeling to many patients.
Diabetic or obese patients and those with decreased immunity may require a prolonged stay in the hospital.
Treatment only with the Antibiotics is a poor alternative to the surgery because antibiotics do not penetrate the fluid within the cavity.
Many ruptured abscesses progress to the fistula formation. Experience suggests that fewer than fifty per cent cases do not develop a fistula.
Strict follow up is essential for complete treatment.
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