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Published in: World Journal of Surgery 2/2017

01-02-2017 | Scientific Review

Treatment-Based Three-Dimensional Classification and Management of Anorectal Infections

Authors: A. E. Ortega, K. G. Cologne, J. Shin, S. W. Lee, G. T. Ault

Published in: World Journal of Surgery | Issue 2/2017

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Abstract

This article provides a current overview on clinical anatomy, pathophysiology, workup and surgical management of anorectal abscesses. Based on the three-dimensional nature of anorectal abscesses, a novel treatment-based classification is proposed. It examines the basis of a philosophic shift from simple drainage to concomitant definitive treatment of abscesses and their underlying primary fistulous trajectories. Complications are discussed specifically in this context.
Literature
1.
2.
go back to reference Ortega AE, Bubbers E, Liu W, Cologne KG, Ault GT (2015) A novel classification, evaluation, and treatment strategy for supralevator abscesses. Dis Colon Rectum 58:1109–1110CrossRefPubMed Ortega AE, Bubbers E, Liu W, Cologne KG, Ault GT (2015) A novel classification, evaluation, and treatment strategy for supralevator abscesses. Dis Colon Rectum 58:1109–1110CrossRefPubMed
3.
go back to reference Bode WE, Ramos R, Page CP (1982) Invasive necrotizing infection secondary to anorectal abscess. Dis Colon Rectum 25:416–419CrossRefPubMed Bode WE, Ramos R, Page CP (1982) Invasive necrotizing infection secondary to anorectal abscess. Dis Colon Rectum 25:416–419CrossRefPubMed
4.
go back to reference Hartmann H, Quénu EA (1895) Abcès péri-anaux et périrectaux. In: Chirurgie de Rectum vol I. Steinheil, Paris, pp 127–155 Hartmann H, Quénu EA (1895) Abcès péri-anaux et périrectaux. In: Chirurgie de Rectum vol I. Steinheil, Paris, pp 127–155
5.
go back to reference Read DR, Abcarian H (1979) A prospective survey 474 patients with anorectal abscess. Dis Colon Rectum 22(8):566–568CrossRefPubMed Read DR, Abcarian H (1979) A prospective survey 474 patients with anorectal abscess. Dis Colon Rectum 22(8):566–568CrossRefPubMed
6.
go back to reference Bodenhamer W (1855) Abscess near the rectum and anus. Diseases of the rectum, 2nd edn. J.S. Redfield, New York, pp 169–170 Bodenhamer W (1855) Abscess near the rectum and anus. Diseases of the rectum, 2nd edn. J.S. Redfield, New York, pp 169–170
7.
go back to reference Herr CH, Williams JC (1994) Supralevator anorectal abscess presenting as acute low back pain sciatica. Ann Emerg Med 23(1):132–135CrossRefPubMed Herr CH, Williams JC (1994) Supralevator anorectal abscess presenting as acute low back pain sciatica. Ann Emerg Med 23(1):132–135CrossRefPubMed
8.
go back to reference Guillamin E, Jeffrey RB, Shea WJ, Asling CW, Goldberg HI (1986) Perirectal inflammatory disease: CT findings. Radiology 161:153–157CrossRef Guillamin E, Jeffrey RB, Shea WJ, Asling CW, Goldberg HI (1986) Perirectal inflammatory disease: CT findings. Radiology 161:153–157CrossRef
9.
go back to reference Kulkarnia MV, Mehta SD, Burks DD, Shaff MI (1985) Imaging of the Ischiorectal Fossa. CT J Comput Tomogr 9:329–336CrossRef Kulkarnia MV, Mehta SD, Burks DD, Shaff MI (1985) Imaging of the Ischiorectal Fossa. CT J Comput Tomogr 9:329–336CrossRef
10.
go back to reference Khati NJ, Leweis NS, Frazier AA, Obias V, Zeman RK, Hill MC (2015) CT of acute perianal abscesses and infected fistulae: a pictorial essay. Emerg Radiol 22:329–335CrossRefPubMed Khati NJ, Leweis NS, Frazier AA, Obias V, Zeman RK, Hill MC (2015) CT of acute perianal abscesses and infected fistulae: a pictorial essay. Emerg Radiol 22:329–335CrossRefPubMed
11.
go back to reference Garcia-Granero A, Granero-Castro P, Frasson M, Flor-Lorente B, Carreno O, Espi A, Puchades I, Garcia-Granero E (2014) Management of cryptoglandular subralevator abscesses in the magnetic resonance imaging era: a case series. In J Colorectal Dis 29:1557–1564CrossRef Garcia-Granero A, Granero-Castro P, Frasson M, Flor-Lorente B, Carreno O, Espi A, Puchades I, Garcia-Granero E (2014) Management of cryptoglandular subralevator abscesses in the magnetic resonance imaging era: a case series. In J Colorectal Dis 29:1557–1564CrossRef
12.
go back to reference Maruyama R, Noguchi T, Takano M, Takagi K, Morita N, Kikuchi R, Uchida Y (2000) Usefulness of magnetic resonance imaging for diagnosing deep anorectal abscesses. Dis Colon Rectum 43:S2–S5CrossRefPubMed Maruyama R, Noguchi T, Takano M, Takagi K, Morita N, Kikuchi R, Uchida Y (2000) Usefulness of magnetic resonance imaging for diagnosing deep anorectal abscesses. Dis Colon Rectum 43:S2–S5CrossRefPubMed
13.
go back to reference Cataldo PA, Senagore A, Luchtefeld MA (1993) Intrarectal ultrasound in the evaluation of perirectal abscesses. Dis Colon Rectum 36:554–558CrossRefPubMed Cataldo PA, Senagore A, Luchtefeld MA (1993) Intrarectal ultrasound in the evaluation of perirectal abscesses. Dis Colon Rectum 36:554–558CrossRefPubMed
14.
go back to reference Visscher AP, Velt-Berma RJF (2015) Endoanal ultrasound in perianal fistulae and abscesses. Ultrasound Q 31:130–137CrossRefPubMed Visscher AP, Velt-Berma RJF (2015) Endoanal ultrasound in perianal fistulae and abscesses. Ultrasound Q 31:130–137CrossRefPubMed
15.
go back to reference Vasilevsky CA, Gordon PH (1984) The incidence of recurrent abscesses of fistula-in-ano following anorectal suppuration. Dis Colon Rectum 27:126–130CrossRefPubMed Vasilevsky CA, Gordon PH (1984) The incidence of recurrent abscesses of fistula-in-ano following anorectal suppuration. Dis Colon Rectum 27:126–130CrossRefPubMed
16.
go back to reference Henrichsen S, Christiansen J (1986) Incidence of fistula-in-ano complicating anorectal sepsis: a prospective study. Br J Surg 73:371–372CrossRefPubMed Henrichsen S, Christiansen J (1986) Incidence of fistula-in-ano complicating anorectal sepsis: a prospective study. Br J Surg 73:371–372CrossRefPubMed
18.
go back to reference Ramanujam PS, Prasad ML, Abcarian H, Tan AB (1984) Perianal abscesses and fistulas. a study of 1023 patient. Dis Colon Rectum 27:593–597CrossRefPubMed Ramanujam PS, Prasad ML, Abcarian H, Tan AB (1984) Perianal abscesses and fistulas. a study of 1023 patient. Dis Colon Rectum 27:593–597CrossRefPubMed
19.
go back to reference Waggener HU (1969) Immediate fistulotomy in the treatment of perianal abscess. Surg Clin North Am 49:1227–1233PubMed Waggener HU (1969) Immediate fistulotomy in the treatment of perianal abscess. Surg Clin North Am 49:1227–1233PubMed
20.
go back to reference Kovalcik PJ, Peniston RL, Cross GH (1979) Anorectal abscess. Surg Gynecol Obstet 149:884–886PubMed Kovalcik PJ, Peniston RL, Cross GH (1979) Anorectal abscess. Surg Gynecol Obstet 149:884–886PubMed
21.
go back to reference Eisenhammer S (1978) The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular (intersphincteric) fistulous abscess and fistula. Dis Colon Rectum 21:237–254CrossRefPubMed Eisenhammer S (1978) The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular (intersphincteric) fistulous abscess and fistula. Dis Colon Rectum 21:237–254CrossRefPubMed
22.
go back to reference Doberneck RC (1987) Perianal suppuration: results of treatment. Am Surg 53:569–572PubMed Doberneck RC (1987) Perianal suppuration: results of treatment. Am Surg 53:569–572PubMed
23.
go back to reference Grace RH, Harper IA, Thompson RG (1982) Anorectal sepsis: microbiology in relation to sepsis: a prospective study. Br J Surg 73:371–372 Grace RH, Harper IA, Thompson RG (1982) Anorectal sepsis: microbiology in relation to sepsis: a prospective study. Br J Surg 73:371–372
24.
go back to reference Lai CK, Wong J, Ong GB (1983) Anorectal suppuration: a review of 606 patients. Southeast Asian J Surg 6:22–26 factors influencing the recurrence rate. Br J Surg 60:537–540, 26:27–26 Lai CK, Wong J, Ong GB (1983) Anorectal suppuration: a review of 606 patients. Southeast Asian J Surg 6:22–26 factors influencing the recurrence rate. Br J Surg 60:537–540, 26:27–26
25.
go back to reference Buchan R, Grace RH (1973) Anorectal suppuration: the results of treatment and the factors influencing the recurrence rate. Br J Surg 60:537–540CrossRefPubMed Buchan R, Grace RH (1973) Anorectal suppuration: the results of treatment and the factors influencing the recurrence rate. Br J Surg 60:537–540CrossRefPubMed
26.
go back to reference Henrchsen S, Christiansen J (1986) Incidence of fistula in ano complicating anorectal sepsis: a prospective study. Br J Surg 73:371–372CrossRef Henrchsen S, Christiansen J (1986) Incidence of fistula in ano complicating anorectal sepsis: a prospective study. Br J Surg 73:371–372CrossRef
27.
go back to reference Eykyn SJ, Grace RH (1986) The relevance of microbiology in the management of anorectal sepsis. Ann R Coll Surg Engl 68:237–239PubMedPubMedCentral Eykyn SJ, Grace RH (1986) The relevance of microbiology in the management of anorectal sepsis. Ann R Coll Surg Engl 68:237–239PubMedPubMedCentral
28.
go back to reference Gya D, Fethers J, Brearley K, Jansz A (1989) Perianal sepsis: drainage and fistulotomy or drainage only? (letter). Med J Aust 150:48PubMed Gya D, Fethers J, Brearley K, Jansz A (1989) Perianal sepsis: drainage and fistulotomy or drainage only? (letter). Med J Aust 150:48PubMed
29.
30.
go back to reference Bizos DB (1997) Evaluation of a policy of primary fistulotomy for acute anorectal abscesses. University of Witwatersrand, Johanesburg, p 65 Bizos DB (1997) Evaluation of a policy of primary fistulotomy for acute anorectal abscesses. University of Witwatersrand, Johanesburg, p 65
31.
go back to reference Hebjørn M, Olsen O, Haakansson T, Andersen B (1987) A randomised trial of fistulotomy in perianal abscess. Scand J Gastroenterol 22:174–176CrossRefPubMed Hebjørn M, Olsen O, Haakansson T, Andersen B (1987) A randomised trial of fistulotomy in perianal abscess. Scand J Gastroenterol 22:174–176CrossRefPubMed
32.
go back to reference Schouten WR, van Vroonhoven TJ (1991) Treatment of anorectal abscess with or without primary fistulectomy. Results of a prospective randomized trial. Dis Colon Rectum 34:60–63CrossRefPubMed Schouten WR, van Vroonhoven TJ (1991) Treatment of anorectal abscess with or without primary fistulectomy. Results of a prospective randomized trial. Dis Colon Rectum 34:60–63CrossRefPubMed
33.
go back to reference Ho YH, Tan M, Chui CH, Leong A, Eu KW, Seow-Choen F (1997) Randomized controlled trial of primary fistulotomy with drainage alone fro perianal abscess. Dis Colon Rectum 40:1435–1438CrossRefPubMed Ho YH, Tan M, Chui CH, Leong A, Eu KW, Seow-Choen F (1997) Randomized controlled trial of primary fistulotomy with drainage alone fro perianal abscess. Dis Colon Rectum 40:1435–1438CrossRefPubMed
34.
go back to reference Oliver L, Lacueva FJ, Perez Vicente F, Arroyo A, Ferrer R, Cansado P, Candela F, Calpena R (2003) Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment. Int J Colorectal Dis 18:107–110PubMed Oliver L, Lacueva FJ, Perez Vicente F, Arroyo A, Ferrer R, Cansado P, Candela F, Calpena R (2003) Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment. Int J Colorectal Dis 18:107–110PubMed
35.
go back to reference Lunniss PJ, Phillips RKS (1994) Surgical assessment of acute anorectal sepsis is a better predictor of fistula than microbiological analysis. Br J Surg 81:368–369CrossRefPubMed Lunniss PJ, Phillips RKS (1994) Surgical assessment of acute anorectal sepsis is a better predictor of fistula than microbiological analysis. Br J Surg 81:368–369CrossRefPubMed
37.
go back to reference Ayres M (1884) Abscess of the rectum. In: Some of the diseases of the rectum and their homeopathic surgical treatment. Duncan Brothers, Chicago, p 62 Ayres M (1884) Abscess of the rectum. In: Some of the diseases of the rectum and their homeopathic surgical treatment. Duncan Brothers, Chicago, p 62
38.
go back to reference Kyle S, Isbister WH (1990) Management of anorectal abscesses: comparison between traditional incision and packing and de pezzer catheter drainage. Aust N Z J Surg 60:129–131PubMed Kyle S, Isbister WH (1990) Management of anorectal abscesses: comparison between traditional incision and packing and de pezzer catheter drainage. Aust N Z J Surg 60:129–131PubMed
39.
go back to reference Beck DE, Fazio VW, Lavery IC, Jagelman DG, Weakley FL (1988) Catheter drainage of ischiorectal abscesses. South Med J 81:444–446CrossRefPubMed Beck DE, Fazio VW, Lavery IC, Jagelman DG, Weakley FL (1988) Catheter drainage of ischiorectal abscesses. South Med J 81:444–446CrossRefPubMed
40.
go back to reference Perera AP, Am H, Sodergren MH, Farne H, Darzi A, Pukayastha S, Paraskeva P (2015) A pilot randomized control trial evaluating postoperative packing of the perianal abscess. Langenbecks Arch Surg 400:267–271CrossRefPubMed Perera AP, Am H, Sodergren MH, Farne H, Darzi A, Pukayastha S, Paraskeva P (2015) A pilot randomized control trial evaluating postoperative packing of the perianal abscess. Langenbecks Arch Surg 400:267–271CrossRefPubMed
41.
go back to reference Sözner U, Gedi E, Kessaf Aslar A, Ergun H, Halil Elhan A, Memikoglu O, Bulent Erkek A, Ayhan KM (2011) Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study. Dis Colon Rectum 54:923–929CrossRef Sözner U, Gedi E, Kessaf Aslar A, Ergun H, Halil Elhan A, Memikoglu O, Bulent Erkek A, Ayhan KM (2011) Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study. Dis Colon Rectum 54:923–929CrossRef
42.
go back to reference Milan M, Garcia-Granero E, Esclapez P, Flor-Lorente B, Espi A, Lledo S (2006) Management of intersphincteric abscess. Colorectal Dis 8:777–780CrossRef Milan M, Garcia-Granero E, Esclapez P, Flor-Lorente B, Espi A, Lledo S (2006) Management of intersphincteric abscess. Colorectal Dis 8:777–780CrossRef
43.
go back to reference Goldberg SM, Gordon PH, Nivatvongs S (eds) (1980) Essentials of anorectal surgery. JB Lippincott Company, Philadelphia, p 110 Goldberg SM, Gordon PH, Nivatvongs S (eds) (1980) Essentials of anorectal surgery. JB Lippincott Company, Philadelphia, p 110
44.
go back to reference Granero-Garcia A, Granero-Castro P, Frasson M, Flor-Llorente B, Carreno O, Garcia-Granero E (2014) The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin. Colorectal Dis 16:335–338CrossRef Granero-Garcia A, Granero-Castro P, Frasson M, Flor-Llorente B, Carreno O, Garcia-Granero E (2014) The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin. Colorectal Dis 16:335–338CrossRef
45.
go back to reference Epstein J, Giordano P (2005) Endoanal ultrasound-guided drainage of intersphincteric abscess. Tech Coloproctol 9:67–69CrossRefPubMed Epstein J, Giordano P (2005) Endoanal ultrasound-guided drainage of intersphincteric abscess. Tech Coloproctol 9:67–69CrossRefPubMed
46.
go back to reference Hippocrates d’ Fistulis (4th-3rd Century B.C.) (1995) In: Potter P (translator) Hippocrates, vol VIII. Harvard University Press, Cambridge, p 387 Hippocrates d’ Fistulis (4th-3rd Century B.C.) (1995) In: Potter P (translator) Hippocrates, vol VIII. Harvard University Press, Cambridge, p 387
47.
go back to reference Gabriel WB (1949) Anorectal abscess. In: The principles and practice of rectal surgery, 4th edn. HK Lewis & Company Ltd, London, pp 188–189 Gabriel WB (1949) Anorectal abscess. In: The principles and practice of rectal surgery, 4th edn. HK Lewis & Company Ltd, London, pp 188–189
48.
go back to reference Hanley PH (1965) Conservative surgical correction of horseshoe abscess and fistula. Dis Colon Rectum 8:264–268 Hanley PH (1965) Conservative surgical correction of horseshoe abscess and fistula. Dis Colon Rectum 8:264–268
49.
go back to reference Tan KK, Liu X, Tsang CB, Koh DC (2012) Identification of the internal anal opening and seton placement improves the outcome of deep postanal space abscess. Colorectal Dis 15:598–601CrossRef Tan KK, Liu X, Tsang CB, Koh DC (2012) Identification of the internal anal opening and seton placement improves the outcome of deep postanal space abscess. Colorectal Dis 15:598–601CrossRef
50.
go back to reference Onaca N, Hirshberg A, Adar R (2001) Early reoperation for perirectal abscess: a preventable complication. Dis Colon Rectum 44:1469–1473CrossRefPubMed Onaca N, Hirshberg A, Adar R (2001) Early reoperation for perirectal abscess: a preventable complication. Dis Colon Rectum 44:1469–1473CrossRefPubMed
51.
go back to reference Tang CL, Chew SP, Seow-Choen F (1996) Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscess with proven internal opening. Dis Colon Rectum 39:1415–1417CrossRefPubMed Tang CL, Chew SP, Seow-Choen F (1996) Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscess with proven internal opening. Dis Colon Rectum 39:1415–1417CrossRefPubMed
52.
go back to reference Knoefel WT, Hosch SB, Hoyer B, Izbicki JR (2000) The initial approach to anorectal abscesses: fistulotomy is safe and reduces the chance of recurrence. Dig Surg 17:274–278CrossRefPubMed Knoefel WT, Hosch SB, Hoyer B, Izbicki JR (2000) The initial approach to anorectal abscesses: fistulotomy is safe and reduces the chance of recurrence. Dig Surg 17:274–278CrossRefPubMed
Metadata
Title
Treatment-Based Three-Dimensional Classification and Management of Anorectal Infections
Authors
A. E. Ortega
K. G. Cologne
J. Shin
S. W. Lee
G. T. Ault
Publication date
01-02-2017
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 2/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3767-8

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