Anal Abscess An anal abscess is a painful condition in which a collection of pus develops near the anus.

Most anal abscesses are a result of infection from small anal glands.

The most common type of abscess is a perianal abscess. This often appears as a painful boil-like swelling near the anus. It may be red in color and warm to the touch. Anal abscesses located in deeper tissue are less common and may be less visible.

Surgical incision and drainage is the most common treatment for all types of anal abscesses and is usually successful.

After an abscess has been drained, however, about 50% of patients will develop a complication called a fistula. A fistula is a small tunnel that makes an abnormal connection between the site of the abscess and the skin.

In some cases, an anal fistula causes persistent drainage. In other cases, where the outside of the tunnel opening closes, the result may be recurrent anal abscesses. The only cure for an anal fistula is surgery.

Causes of Anal Abscesses An anal abscess can have many different causes. These include:

Infection of an anal fissure. An anal fissure is a small superficial tear in the skin of the anal canal. Sexually transmitted infections. Blocked anal glands. Risk factors for anal abscesses include:

Colitis Inflammatory bowel disease such as Crohn's disease or ulcerative colitis

Diabetes Diverticulitis Pelvic inflammatory disease Being the receptive partner in anal sex Use of medications such as prednisone For adults, using condoms during sexual intercourse, including anal intercourse, can help prevent anal abscesses. For infants and toddlers, frequent diaper changes and proper cleaning during diaper changes can help prevent anal fissures and perianal abscesses.

Symptoms of Anal Abscesses Superficial anal abscesses are often associated with:

Pain, which is usually constant, throbbing, and worse when sitting down Skin irritation around the anus, including swelling, redness, and tenderness Discharge of pus Constipation or pain associated with bowel movements Deeper anal abscesses may cause less pain but are often associated with:

Fever Chills Malaise Sometimes, fever is the only symptom of deep anal abscesses.

Diagnosis of Anal Abscesses Usually, a clinical evaluation -- including a digital rectal exam -- is sufficient to diagnose an anal abscess. But some patients may require additional tests to screen for:

Sexually transmitted infections inflammatory bowel disease Diverticular disease Rectal cancer In rare cases, an examination may be done under anesthesia. The doctor may also ask for an ultrasound, a CT scan, or an MRI.

Treatment of Anal Abscesses Prompt surgical drainage is important, preferably before the abscess erupts. Superficial anal abscesses can be drained in a doctor's office using a local anesthetic. Large or deeper anal abscesses may require hospitalization and the assistance of an anesthesiologist.

After the procedure, most people are prescribed medications for pain relief. For otherwise healthy people, antibiotics are usually not needed. Antibiotics may be required, though, for some people, including those with diabetes or decreased immunity. (continued) Treatment of Anal Abscesses continued... Sometimes, fistula surgery can be performed at the same time as abscess surgery. However, fistulas often develop four to six weeks after an abscess is drained. Sometimes a fistula may not occur until months or even years later. So fistula surgery is usually a separate procedure that can be performed on an outpatient basis or with a short hospital stay.

After abscess or fistula surgery, discomfort is usually mild and can be controlled with pain medications. People can expect to lose only a minimal amount of time from work or school.

People are usually advised to soak the affected area in a warm water (sitz) bath three or four times per day. Stool softeners may be recommended to ease the discomfort of bowel movements. Some people may be advised to wear a gauze pad or mini-pad to prevent the drainage from soiling their clothes.

Complications after surgery can include:

Infection Anal fissure An abscess returning Scarring After an anal abscess or fistula has properly healed, it's unlikely that the problem will come back. To prevent one from doing so, however, it's important to follow the advice of your doctor or colon and rectal surgeon. http://www.webmd.com/a-to-z-guides/anal-abscess?page=2

a. Definisi Fistulotomy merupakan tindakan bedah untuk mengobati anal fistula dengan cara membuka saluran yang menghubungkan anal canal dan kulit kemudian mengalirkan pus keluar. Fistulotomy dikerjakan bila saluran fistula melewati spingter ani, dan bila tidak melewati spingter ani maka dilakukan Fistulectomy. b. Ruang lingkup Kelainan perianal yang menimbulkan saluran penghubung yang abnormal antara kulit dan anal canal yang membutuhkan tindakan pembedahan c. Indikasi operasi Untuk mengalirkan pus serta menutup saluran fistula serta mempertahankan fungsi defekasi tetap normal d. Macam operasi Fistulotomi simple seton e. Kontra indikasi Fistel perianal yang disebabkan proses keganasan f. Diagnosis Banding

Inflammatory bowel disease Hydradenitis superativa Sinus pilonidal

g. Pemeriksaan penunjang

CT Scan Fistulografi MRI

Teknik Operasi

A. Posisi pasien litotomi atau knee chest : 1. 2. Dilakukan anestesi regional atau general Sebelum melakukan operasi sangat penting untuk meraba adanya jaringan fibrotik saluran fistel di

daerah perianal maupun dekat linea dentata, sehingga dapat ditentukan asal dari fistel 3. Dengan tuntunan rektoskopi dicari internal opening dengan cara memasukkan methilen blue yang dapat dicampuri perhidrol 4. Bila internal opening belum terlihat dilakukan sondage secara perlahan dengan penggunaan sonde tumpul yang tidak kaku kedalam fistula dan ujung sonde diraba dengan jari tangan operator yang ditempatkan dalam rektum 5. Bila internal opening telah ditemukan, dengan tuntunan sonde, dapat dilakukan fistulotomi yaitu dengan cara insisi fistula searah panjang fistula dan dinding fistula dilakukan curettage untuk pemeriksaan patologi. Hati-hati jangan sampai memotong sfingter eksterna. 6. Luka operasi ditutup dengan tampon. h. Komplikasi Operasi Komplikasi yang dapat timbul berupa perdarahan, inkontinensia fecal, retensio urine, infeksi, serta komplikasi akibat anesthesia. i. Mortalitas Tergantung dari penyakit yang mendasarinya j. Perawatan pasca Bedah Hari pertama penderita sudah diperbolehkan makan. Antibiotika dan analgetik diberikan selama 3 hari. Pelunak feces dapat diberikan pada penderita dengan riwayat konstipasi sebelumnya. Tampon anus dibuka setelah 224 jam atau jika terdapat perdarahan dapat dibuka sebelumnya. Rawat luka dilakukan setiap hari. Setelah penderita mampu mobilisasi, penderita diminta rendam duduk 2x sehari dengan larutan Permanganas Kalikus (KMNO4) selama 20 menit.