referat perianal abses

5/22/2018 REFERAT PERIANAL ABSES

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PERIANAL ABSES

Senoadji Pratama, S.Ked

102011101030

SMF Bedah RSD. dr. Soebandi Jember

Fakultas Kedokteran Universitas Jember2014

REFERAT

Pembimbing :

dr. Adi Nugroho, Sp.B


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ANATOMI


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DEFINISI

Infeksi jaringan lunak di sekitar kanalisanalis, disertai dengan pembentukan

rongga abses.


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EPIDEMIOLOGI

Abses anorektal dan fistula terjadi padadekade 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)


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ETIOLOGI

Nonspecific :

Cryptoglandular in origin.

Specific :

CrohnsUlcerative colitis

TB

Carcinoma, Lymphoma, Leukemia

Trauma

Pelvic inflammation


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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.


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Patofisiologi Cont

A = Infeksi dari usus menyerang kriptus

analis atau kelenjar analis lain. Prosesprimer ini terjadi pada linea dentata .

B & C = Infeksi menyebar ke jaringan perianaldan perirektal secara tidak langsungmelalui system limfatik atau secaralangsung melalui struktur kelenjar.

D = Terbentuk abses

E = Abses pecah spontan, menorehkanlubang pada permukaan kulit perianaldan terbentuk fistula komplit

F = Fistula


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PENYEBARAN ABSES


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Penyebaran abses cont

Dari 1000 pasien yang didiagnosis anorektalabses, terdapat:

1. Perianal abses 42,7 %,

2. Ischiorektal 22,7 % ,3. Intersfingter 21,4%

4. Supralevator 7,33% .

(Hamadani et al, 2009)


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KLASIFIKASI ABSES


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Initial Evaluation of Perianal Abscess and

Fistula-in-Ano(American Society of Colon and Rectal Surgeons,2005)

Disease-specific history and physical examination should beperformed

Emphasizing on: Symptoms

Risk factors

Location Presence of secondary cellulitis

Presence of fistula-in-ano

It is important to distinguish anorectal abscess from otherperianal 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)


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DIAGNOSIS

Clinical presentationAbscess

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


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DIAGNOSIS BANDING

Fissura anal Thrombosis Hemoroid

Fistula anal


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PEMERIKSAAN PENUNJANG

MRI

EUS

CT Scan

EUA


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TERAPI

TreatmentAbscess

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


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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)


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Insisi dan drainase abses


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KOMPLIKASI

Setelah dilakukan drainage abses, 37% sampai 50%

pada pasien akan berkembang menjadi Abses

reccurent atau fistula anal.(Fazio V, 1987)


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referat perianal abses

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