Perianal abscess (acute paraproctitis) is the development of abscess in the rectum. This is a serious pathology that requires an urgent surgical intervention. Without timely surgery, a person may develop severe, potentially fatal complications. The high-quality treatment abroad allows the patients to get rid of an abscess once and for all, preventing the disease from becoming chronic. Medical specialistst in Europe perform sparing surgical interventions with the preservation of anal sphincter function.
Content
- Symptoms
- Diagnostics
- Treatment principles
- Single-stage treatment
- Two-stage treatment
- Where to undergo treatment
Symptoms
Perianal subcutaneous abscess is the most common pathology. It accounts for half of all clinical cases. The disease is characterized by a sudden onset of severe pain. It gets worse during defecation and intensifies with any movement. When examining the patient, the physician detects swelling and redness.
The second most frequent form of the disease is ischiorectal abscess. The pain is less severe, but general symptoms are more common. The body temperature may increase up to 40 degrees. When examining the patient, the doctor pays attention to the asymmetry of the buttocks, as one of them is swollen, so it increases in size.
Pelvirectal abscesses often imitate prostate inflammation. Patients may develop acute urinary retention and pelvic pain.
Submucosal abscesses have mild symptoms. Patients often do not seek medical help. As a result, the abscess opens up on its own, and the disease becomes chronic.
Diagnostics
The following steps are required for diagnosis of perianal abscess:
- Patient interview.
- Check-up.
- Digital rectal examination.
- Fistulography (X-ray examination with the injection of a contrast agent).
- Endorectal ultrasound scanning (with the placement of the transducer in the rectum).
- Bacteriological examination involves obtaining pus culture to determine the causative agent of the pathology.
Additional methods of medical imaging are used less commonly. These can be computed tomography or magnetic resonance imaging.
Treatment principles
Conservative therapy is ineffective. Even in case of successful suppression of the acute inflammatory process, the disease will necessarily recur or become chronic.
To avoid the spread of the infectious process to other tissues, the surgical treatment is carried out as quickly as possible. Without timely surgery, destruction of the anal sphincter, death of the intestinal wall or destruction of the pelvic floor muscles can occur.
The surgical treatment can be single-stage or two-stage. A more reliable option is to perform two operations: first, an abscess is opened, and after a few days a radical intervention is performed to cure acute paraproctitis.
Single-stage treatment
If the pus passage is located inside from the external sphincter, then the abscess is opened, drained, and the pus passage is excised into the intestinal lumen. To detect the fistulous passage, the doctor uses a dye. To clarify the location of the passage in relation to the anal sphincter, a test with a bellied bougie is performed. Then a wide skin incision is made and the tissues affected with the inflammation are excised.
Some patients develop abscess due to intersphincteric paraproctitis. In such a case, a sphincterotomy is required. This procedure implies the dissection of the sphincter. The doctor dissects the internal sphincter and drains the space into the intestinal lumen.
With transsphincteric paraproctitis, if the inflammatory process affects more than one fifth of the sphincter, or the pus passage is located outside of it, an elastic drainage ligation is performed. This is a treatment option for patients who are considered to be at high risk of developing sphincter insufficiency. The ligation is used in those who cannot undergo sphincterotomy. This type of the operation is used as the first stage of the two-stage treatment process. In the future, the patient will need radical surgery in a few days.
Two-stage treatment
The two-stage treatment is considered more reliable. Its essence lies in the fact that during the first operation, the abscess is opened, and drainage is placed to drain the inflammatory fluid. After the elimination of the inflammatory process, after 5-7 days, a second intervention is performed, the purpose of which is to completely eliminate the connection between the intestine and the pus cavity. Such an approach provides a lower risk of complications.
Although the patient actually recovers after the first operation, the second stage of surgical treatment cannot be avoided. Otherwise, the patient will have a recurrence or a fistula will ccur – a pathological connection between tissues (chronic paraproctitis).
Where to undergo treatment
To receive the highest level of medical care, you can undergo treatment of perianal abscess abroad. The specialists of the Booking Health company will select the best clinics for the treatment of perianal abscess for you. We will take care of the arrangement of your urgent treatment and emergency surgical debridement of an abscess in one of the developed countries.
There are several reasons for you to undergo perianal abscess treatment abroad:
- Doctors prefer two-stage surgery. It provides more reliable results with less risk of complications.
- Provision of additional antibacterial treatment aimed at reducing the risk of infectious complications.
- Adequate pain relief both during the surgery and in the postoperative period.
- Minimal risk of fecal incontinence. When there is a high risk of damage to the sphincter function, doctors prefer more sparing types of surgery.
- The risk of the disease recurrence or transition to a chronic form (formation of a fistula) is almost close to zero.
- Extensive experience in the diagnostics and treatment of even rare types of abscess: intermuscular, submucosal, bilateral ones.
- High-quality postoperative care and recovery.
Please leave your request on the Booking Health website. Our specialist will contact you within just a few hours. If you book a medical care program via our service, the cost of the operation will be lower due to the lack of additional coefficients for foreign patients. You can compare prices in different hospitals in order to book your treatment at the best price.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
National Library of Medicine
Mayo Clinic
UpToDate
