Abscess and anal fistula represent two different stages of a single pathology: while abscess is an acute event, fistula represents a chronic evolution of the acess, but both are always correlated.

    INDEX: 1. WHAT IS ANORTHICAL ABCESS 2. THE CAUSES OF ANORTHICAL ABCESS 3. CLASSIFICATION OF ASCESSES 4. SYMPTOMS OF ANORTHICAL ABSCESS 5. TREATMENT OF ANORETIC ABSCESS 6. GENERAL INFORMATION AFTER ANAL ASCESS 1. WHAT IS ANORTHICAL ABSCESS It is a collection of Pus in the anal area and at the end of the rectum. In spite of what was said in the past, proper treatment of these pathologies requires the special surgeon to have detailed abilities and knowledge of the anatomy of the anorectal area. 2. THE CAUSES OF ANORTHICAL ABSCESS 90% of anorectal abscesses are caused by an infection of small glands inside the anal canal, a so-called cryptosandal infection ... to better explain it is similar to what happens to the skin for follicles, for so-called "hairy hairs" , The gland near the hair is infected, forms the simplest case of a "pimple" but in the most serious cases a real abscess or forunculus. You think the same thing can be formed within the anus but with a much larger bacterial charge, so the infection is certainly more serious. There are predisposing factors such as diarrhea and the opposite of very severe stools. However, there are other causes. The most common are some chronic intestinal diseases such as Crohn's Disease and Ulcerative Rectalcolitis. Do not overlook the abscesses that come as follow after interventions on hemorrhoids and stingers, and rarely also for foreign bodies that penetrate into the anal canal, like thorns and small ossicles. Whatever the cause, an anorectal abscess always comes from the rectum or anus, this communication path is called FISTULA. Therefore where there is an abscess there is always a fistula. 3. CLASSIFICATION OF ASCESSES Depending on the venue, several abscesses are recognized, whose knowledge is important for the treatment. The most common and most frequent venue is the perianal, while the others stand out from the sphincter muscles (very important muscles, we have two, one inside and one outside, which are able to withstand the stool and the air). Then we recognize perianal, ischioretic, interspecific, and ascending abscesses. Sometimes they extend from one side to the other of the anus, the so-called horseshoe abscesses. 4. SYMPTOMS OF ANORTHICAL AUCTION Symptoms of anorectal abscess are acute with pain, fever, swelling and redness. When a patient tells me they have pain in the anus or around with fever, I'm almost sure she has an abscess and no hemorrhoids she often gets confused with. In these cases, the white blood cells are very high. The visit with rectal exploration however removes any doubt from the surgeon. It is often not possible to do an anoscope for the acute pain that it would cause. In rare cases, magnetic resonance may be required. 5. TREATMENT OF ANORETIC AUCTION As a general principle of any abscess, treatment consists essentially of: incision and drainage of pus collection. The procedure should be performed as soon as possible to prevent the infection from spreading. Relief is immediate, pain and fever disappear and the tests return to normal. More superficial abscesses drain into local anesthesia and sedation, while the more complex and horseshoe will be treated in spinal or general anesthesia. Generally, a drainage that can go from a piece of sterile glove (the so-called glove finger) to a small tubular drainage to a gauze leaves. The period in which the drainage is to be kept varies according to the case, and sometimes it has to be replaced after a few days. There is some controversy about whether to treat abscess and fistula together or just abscess and then fistula. Personally, after draining the iniquitous abscess of oxygenated water with a blue dye in the cavity, if I see it coming out of the inside of the anus or rectum, then I pointed the fistula and stroke immediately. This greatly reduces the possibility of relapse of the acess. The dressings are no longer painful as a time since it has been seen that it is not necessary to fill the remaining cavity completely, just put a snout that prevents the wound too soon. The wound will remain open for a minimum of two weeks up to two months with dressings initially bi-weekly and then weekly. 6. POSTOPERATORY INFORMATION AFTER INTERVENTION ASCESS ANALYSIS OF Dr. Carlo Farina After surgery, the anal area remains painless thanks to a painkillers treatment at fixed doses and times that will continue to be home and allow for regular life. Probably at the level of the wound there is a gauze or surge that will be replaced during the ambulatory dressings that will be initially bi- or tri-weekly. They are not painful dressings, gauze will be gently detached after they are wet. Defecation is no longer a worrying event, if it does not happen spontaneously within 2 days, you will be given a mild laxative. It could be accompanied by red blood, mixed with clots and loss of "sapphire". No worries, just wash with plenty of water and betadine soap or eucloline: 2 sachets loose in the bidet water, using disposable gloves if necessary. We will think about the surgeon during the subsequent dressing to reposition it. If it is present, the "silk" does not need any attention. Do not stay long on the water and do not use toilet paper. It may be useful to use the shower phone to remove any debris. Use a "donut" if necessary to avoid crushing the wound from sitting. Work can be taken between the 5th and 10th day after the intervention. During the postoperative period, he or she may have a regular life avoiding long journeys for seven days, bicycle and motorbike for at least 2 weeks. It will have to boost a rich fiber supply and eliminate alcohol, coffee, chocolate, spices and spicy foods. We recommend for the first 7-10 days to apply an analgesic ointment before and after defecation. After the intervention you can observe one of the following situations: • Pain, anal and rectal burn, especially if you do not follow the analgesic therapy at a time. • Red or pink, then yellowish, mild, even deodorant blood loss, which lasts until the last incision (1-3 months) is completely cleaved. Frequent washing with water is advisable. It is useful to use absorbents. • Irritation of the skin around the vessel which appears reddened and it causes itching and burning. It is caused by leaks or the use of gauze and absorbent or local ointments. These are protective creams. • Temporary difficulty in holding gases. It is caused by dilation of the anus muscle fibers and disappears in about 1 week. • Fever (up to 38 ° C) in the first days after surgery. These situations are normal and planned and should not be a concern, otherwise they will have to alert the surgical team promptly.

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