Anorectal abscesses are commonly caused by obstruction of the anal
ducts, the ducts that drain the anal glands in the anal wall, helping to ease
the passage of fecal matter through mucus secretion. My patient suffered
from fluid stasis as a result of an obstruction of the anal duct, which could
have caused his 18.2 WBC. Most pain patients have severe anal pain that can
be connected to or unrelated to constipation, but is nonetheless constant. I
have found this to be true for my patient since his pain intensity level ranges
from 7 to 10. This is due to infection of the anal glands, which are not
adequately draining through the anal crypts. The anal glands empty into
ducts that traverse the internal sphincter and drain into the anal crypts at the
level of the dentate line. Without adequate draining, infection of these glands
can result in an abscess that can spread along multiple planes, such as the
perianal, as in my patient's case, or the perirectal space. Around the anus,
the perianal space connects with the fat of the buttock. After fluid collects, it
can spread along the path of least resistance, which is commonly the
intersphincteric space and other potential spaces, such as the supralevator
or ischiorectal space. The organisms responsible for these abscesses
include Clostridium species, Staphylococcus aureus, Streptococcus, and
Escherichia coli. In most cases, a physical exam is all that is needed to
diagnose. Patients with abdominal pain that does not seem to have an
explanation or those with compromised immune systems who might not
mount an immune response may benefit from computed tomography or
magnetic resonance imaging in the absence of the above symptoms and
signs of infection. As was evident in my patient's case, laboratory testing
usually reveals an elevated white blood cell count. In my patient's case,
antibiotic therapy was initiated with Vancomycin and Zosyn. A proper
analgesic should also be administered to the patient. Incision and drainage
are the most common treatments for perianal abscesses. These can heal
themselves with the secondary intention. In order to detect potential fistulasin-ano, protoscopy should be performed following drainage. The surgeon
should consider inserting a seton if a fistula is identified; however, the tract
should be clearly identifiable without unnecessary probing if a fistula is
found. There is limited evidence to suggest that postoperative antibiotics
following drainage of anorectal abscesses may lower the risk of fistula
formation, a huge complication of perianal abscess. Other complications
include Sepsis and recurrent abscesses.
References:
Banasik, J. L. (2018). Pathophysiology - E-book. Elsevier Health Sciences.
Leeuwen, A. M., & Bladh, M. L. (2021). Davis's comprehensive manual of
laboratory and diagnostic tests with nursing implications. F.A. Davis.