Anorectal sepsis: a problem still not always optimally treated

ABSTRACT

254 patients suffering from anal or anorectal sepsis were included in this work, 183 were males and 71 were females, [sex ratio MF 2.581]. Age ranged from 7 to 93 years, a mean age of 32.7 +/- 12.3 years. 48.8% were found to have a history of previous sepsis. Bacterial cultures showed bowel derived organism in 50.6% of cases, skin derived organism in 23.5%, mixed growth in 19.7% and in 6.2% cultures were sterile due to antibiotics intake. Abscesses were found in 147 patients, ischiorectal abscesses were found in 83 [56.57%], perianal abscess in 26 [17.68%], submucous abscess in 6 cases [4.08%]. Adequate linear drainage was done for all, but associated partial internal sphincterotomy was added in 62 cases [42.17%], 32 with intersphincteric abscesses and 30 with ischiorectal abscesses. Anal fistulae were detected in 38 cases [37.3%] out of 102 patients who could be followed up for a period of 6 months to 2 years and it was found that cases complicated after drainage by anal fistulae had no sphincterotomy during the initial drainage procedure. 107 patients presented by anal fistulae, low intersphincteric or transphincteric fistulae making the highest finding [79.4%] of all fistulae. Fistulectomy could be done as one stage operation in all except in one of submucous fistula and two stage fistulectomy was done for 3 cases of suprasphincteric fistulae. Recurrences were detected in 5 cases [6.7%] after a follow-up for 6 months to 2 years. The overall recurrences in this group of patients was 24.4%. Adequate abscess drainage associated with partial internal sphincterotomy for cases with ischiorectal and intersphincteric abscesses is the key to avoid recurrence of anorectal sepsis, cultures should be done for all cases with anorectal sepsis and cases showing bowel derived organisms should be considered risk group and should be followed up to detect and treat possible recurrences