A clinical study on perianal abscess

BACKGROUND: A perianal abscess is an acute phase manifestation of a collection of pus that arises from infection of cryptoglandular epithelium lining the anal canal or from a skin infection. Surgical drainage is the cornerstone of treatment for perianal abscesses. They represent approximately 60% of reported anorectal abscesses. Although perianal abscess is common in healthy individuals there are other risk factors that are strongly associated such as diabetes , crohn’s disease, obesity, immunosuppression, anal fissure etc. Isolation of gut specific organisms from the pus from a perianal abscess would suggest that a fistula may be present and a careful review of the case is necessary. This study describes the incidence of perianal abscess in different sex and age groups, the complications and the risk factors associated. OBJECTIVES: The aim of this study is to identify the most common risk factor causing perianal abscess, to identify the most common age group involved, to identify the most common organism grown in culture and the sensitive antibiotic group and to study the most common complications associated. METHODS AND MATERIALS: 100 patients who present with perianal abscess in GovtKilpauk Medical College for a period of 7 months from Jan 2015 to July 2015 are included in the study. Patients under the age group of 10 yrs, recurrent perianal abscess and other types of anorectal abscess are excluded from the study. RESULTS: In this study 63% were males and 37% were females and the mean age of male and female patients was 42.3+11.8 yrs (range 21-80) and 37.6+7.4 yrs (range 19- 50) respectively.The most common presenting feature was pain which was present in all patients (100%) followed by swelling (78%), fever (23%) and discharge (6%). Majority of patients had abscesses in the lateral location with 34% of abscesses in the right lateral side and 31% of abscesses in the left lateral side, followed by 29% of abscesses in the posterior location and the least (6%) in the anterior relation of anal canal.Of the 100 specimens, all except 10 specimens yielded bacterial growth. Aerobic bacteria only were isolated in 80 patients (80%), anaerobic bacteria only in 4 patients (4%), mixed aerobic and anaerobic bacteria in 6 patients (6%). A total of 10 anaerobic and 86 aerobic isolates were recovered from 100 abscesses. The predominant isolates were Escherichia coli (n = 39),Staphylococcus aureus (n=16), Proteus mirabilis (n=12), Enterococcus spp. (n=11), Bacteroids fragilis (n=10), Klebsiella (n=9).An underlying condition was present in 34 patients out of 100 patients. A single condition was present in 24 patients, two comorbid conditions were present in 9, and three comorbidity were present in one. Diabetes mellitus (23%), hypertension (6%), and obesity (13%) were the most common conditions. One patient had AIDS and another one patient had HBsAg infection. The patients were followed for a period of three months. 94% of patients developed no complications. Complications occurred in six patients. Of these five patients developed fistula in ano and one presented with recurrent abscess. CONCLUSION: Perianal abscesses are more common in men than in women. Majority of the aerobic and anaerobic organisms cultured from the perianal abscesses are of GIT and skin flora origin. Isolation of gut specific organisms from the pus from a perianal abscess would suggest that a fistula may be present and a careful review of the case is necessary. Whereas if skin organisms are grown in culture further evaluation is unnecessary. Incision and drainage is the main treatment for perianal abscess. An anal fistula indicates a chronic phase of an unhealed abscess. Because of this after drainage of perianal abscesses it is advised to do careful examination under anaesthesia seven to ten days later when the results of culture and sensitivity are available to look for an underlying fistula