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PERIANAL ABSES

Senoadji Pratama, S.Ked


102011101030
SMF Bedah RSD. dr. Soebandi Jember
Fakultas Kedokteran Universitas Jember
2014
REFERAT
Pembimbing :
dr. Adi Nugroho, Sp.B

ANATOMI
DEFINISI
Infeksi jaringan lunak di sekitar kanalis
analis, disertai dengan pembentukan
rongga abses.
EPIDEMIOLOGI
Abses anorektal dan fistula terjadi pada
dekade 3 sampai 4.
Abses perianal pada laki-laki lebih sering
terjadi 2 -3 kali dari wanita. (Gordon,1992)
Penyebab 90 % abses perianal adalah
nonspesifik yang disebabkan karena infeksi
cryptoglandular (Chiari & Park, 1878)
ETIOLOGI
Nonspecific :
Cryptoglandular in origin.

Specific :
Crohns
Ulcerative colitis
TB
Carcinoma, Lymphoma, Leukemia
Trauma
Pelvic inflammation

PATOFISIOLOGI
The cryptoglandular hypothesis states that
infection of the anal glands associated with
the anal crypts is the primary cause of anal
fistula and abscess.
Patofisiologi Cont
A = Infeksi dari usus menyerang kriptus
analis atau kelenjar analis lain. Proses
primer ini terjadi pada linea dentata .
B & C = Infeksi menyebar ke jaringan perianal
dan perirektal secara tidak langsung
melalui system limfatik atau secara
langsung melalui struktur kelenjar.
D = Terbentuk abses
E = Abses pecah spontan, menorehkan
lubang pada permukaan kulit perianal
dan terbentuk fistula komplit
F = Fistula

PENYEBARAN ABSES
Penyebaran abses cont
Dari 1000 pasien yang didiagnosis anorektal
abses, terdapat:
1. Perianal abses 42,7 %,
2. Ischiorektal 22,7 % ,
3. Intersfingter 21,4%
4. Supralevator 7,33% .

(Hamadani et al, 2009)
KLASIFIKASI ABSES
Initial Evaluation of Perianal Abscess and
Fistula-in-Ano
(American Society of Colon and Rectal Surgeons,2005)
Disease-specific history and physical examination should be
performed
Emphasizing on:
Symptoms
Risk factors
Location
Presence of secondary cellulitis
Presence of fistula-in-ano
It is important to distinguish anorectal abscess from other
perianal suppurative processes
Anoscopy and sigmoidoscopy may be performed
In general, laboratory evaluation is not necessary

Grade of Recommendation: Strong recommendation based on low-quality evidence (1C)

DIAGNOSIS
Clinical presentation Abscess
Perianal pain, discharge (pus) and fever
Tender, fluctuant, erythematous subcutaneous lump
Perianal
Chills, fever, ischiorectal pain
Indurated, erythematous mss, tender
Ischio-rectal
Rectal pain, chills and fever, discharge
PR tender. Difficult to identify are. EUA needed
Intersphincteric
Supralevator
DIAGNOSIS BANDING
Fissura anal
Thrombosis Hemoroid
Fistula anal
PEMERIKSAAN PENUNJANG
MRI
EUS
CT Scan
EUA
TERAPI
Treatment Abscess
Incision and drainge de-roof cavity
Pack with gauze and iodine
IV AB, sitz bath tid, laxitives and analgesia
F/U for fistula
Perianal
Ischio-rectal
I&D through interspgincteric plane.
Treat the underlying cause
Intersphincteric /
Supralevator
Aim:
adequate drainage of abscess preservation of sphincter function


Management of Perianal Abscess
(American Society of Colon and Rectal Surgeons,2005)

Patients with acute anorectal abscess should be treated in a
timely fashion with incision and drainage
Keep incision as close as possible
Adequately sized elliptical or cruciform incision
Recurrence rate range between 3%-44%
Incomplete initial drainage
Failure to break up loculations
Missed abscess
Undiagnosed fistula

Grade of Recommendation: Strong recommendation based on low quality evidence
(1C)




Insisi dan drainase abses
KOMPLIKASI
Setelah dilakukan drainage abses, 37% sampai 50%
pada pasien akan berkembang menjadi Abses
reccurent atau fistula anal.(Fazio V, 1987)