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Old 06-01-2001, 12:33 PM   #1
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Join Date: May 2001
Location: New York, NY, 10028
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Isabelle HB User
Abscess...need advice???

hi i tried posting this on the digestive board, but didn't get any replies. i am a 22 yr. old female with a recurring perirectal abscess. The 1st one was 2 yrs ago and it has come back 5 times. all but 2x i had to get it drained. it is an excruciating exp. overall. the doctors i have been to suspect that i have crohn's (other symtoms are present too, mouth ulcers, nauseau, diareah etc) and i am getting tested next week.i want to know if any one has had exp. w/ this type of abscess?? please help..... i don't ever want to go through getting another one. does anyone know anything about a fistulotomy- is that always necessary or if i do have crohn's and get that under control would it prevent me from getting more abscesses???????

 
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Old 06-01-2001, 01:47 PM   #2
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Re: Abscess...need advice???

I had never heard of this until you posted, but after searching the web this is what I learned:

"An anorectal (perirectal) abscess and an anorectal fistula have a common origin. The abscess is an acute problem and the fistula is a subsequent chronic problem. A fistula is an abnormal communication between the anal canal and the perianal skin.

In 90% of cases of perirectal abscess, the source of the abscess is an infection occurring in glands which empty into the anal canal. Usually, no specific cause of this infection can be found and it is termed a cryptoglandular Infection. A cryptoglandular infection may occasionally be seen in association with a diarrheal illness, anal fissure, tuberculosis, Crohnís disease, and AIDS.

Non-cryptoglandular infection (less than 10%) occurs secondary to trauma, a foreign body or cancer of the rectum. Rarely an intraabdominal source of infection may result in a perirectal abscess.

A patient with a perirectal abscess presents to the surgeon with persistent rectal pain (unlike anal fissure in which the pain occurs following defecation), perirectal swelling, possible fever and drainage if the abscess has ruptured. An abscess may be diagnosed by inspection of the tissue around the rectum or by digital palpation. Occasionally endoscopic examination is required if not too painful. In a small number of patients with severe pain, examination under anesthesia is required for diagnosis. Treatment is rendered at that time.

The treatment of a perirectal abscess is adequate surgical drainage. There is no role for antibiotics as primary treatment; they may be used in conjunction with surgical drainage in some cases. Small abscesses can be drained in the office with the use of local anesthestics. At least one-half of abscesses require drainage under anesthesia, either general anesthesia or spinal anesthesia.

Following rupture of an abscess or following surgical drainage, a fistula may (but not necessarily) develop. Signs of a fistula include persistent drainage and recurrent abscess formation. The presence of a symptomatic fistula is an indication for surgery. Fistulas rarely heal and are associated with recurrent abscesses. Rarely, a long standing fistula may be the site of development of a cancer. Surgical treatment of a fistula usually means complete incision of the fistula (fistulotomy).

The goal of treatment of a fistula is complete eradication of the fistula and maintenance of fecal continence. Fistulas can be simple problems with the diagnosis obvious and treatment straight forward. In a small percentage of cases, the fistula may be difficult to identify and eradicate. Multiple operations may thus follow.

If at the time of drainage of a perirectal abscess a fistula is identified, surgical treatment of the fistula may be carried out. If a definite fistula can not be identified, the best treatment may be simply to drain the abscess and caution the patient that he may need further surgery should a fistula develop.

A fistula usually involves some portion of the anal sphincter muscle and correction of the fistula requires division of a portion of the muscle. The most significant complication of surgery for a fistula is fecal incontinence. If this occurs, the sphincter muscle can be subsequently repaired.

The treatment for a fistula associated with other conditions is treatment of the primary condition.

Some infections and abscesses may occur near the rectum, but do not originate in the rectum. A Bartholinís abscess originates in the vagina. Infections may involve the perianal skin or its appendages. These include infected pilonidal cysts, hidradenitis originating in sweat glands, and infected sebaceous cysts.

Infection of the perirectal tissues may also originate from infections of the urinary system. The treatment of these infections is treatment of the underlying source."

"A fistula is a form of infection around the rectum. It is an abnormal, thin tunnel that connects the inside of the rectum with the outside through a small hole that is located to the side of the rectum. A fistula will usually leak blood-stained pus (cloudy fluid), because, as mentioned, it is a form of mild infection. There usually is some discomfort, but this condition isn't really painful. When the openings of the fistula become plugged an infection (abscess) results. A fistula will not heal without surgical treatment."

Seems like the recurrent abscesses are coming from a fistula and the fistulotomy is the surgical removal of it so that it doesn't continue to abscess and surgery was the only option listed in every article I read. From what I read, if you are diagnosed with Crohn's, and you get the symptoms of it under control then it should help prevent future occurrences of the fistula/abscesses.

Hope this has helped some!!

Good Luck to you!

Sherri.

 
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