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Perianal and Pilonidal abscess

Perianal and Pilonidal abscess. Dr. Kirsty Cattle SHO to Mr. Woodward. Perianal abscess. Collection of pus in the perianal area Common surgical problem, any age, M>F Appearance: Red, swollen, hot, tender, indurated, fluctuant centre, discharging. Cause:

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Perianal and Pilonidal abscess

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  1. Perianal and Pilonidal abscess Dr. Kirsty Cattle SHO to Mr. Woodward

  2. Perianal abscess • Collection of pus in the perianal area • Common surgical problem, any age, M>F • Appearance: • Red, swollen, hot, tender, indurated, fluctuant centre, discharging

  3. Cause: • E. coli, Staph aureus, Bacteroides, Strep, Proteus • Infected anal gland • Local trauma • Skin infection • Rectal disease: Crohn’s disease, neoplasm • Immunocompromise, e.g. diabetes, AIDS

  4. Types • Perianal (60%) – spreads superficially to lie in region of subcutaneous portion of external sphincter • Ischiorectal (30%) – spreads laterally through the external sphincter to infect the ishiorectal fossa fat • Submucous (5%) – occurs above dentate line, sometimes after injection of haemorrhoids

  5. Management • Incision and drainage • Packing • ± antibiotics

  6. Pilonidal abscess • Abscess caused by hair fragments working their way into the skin, usually found in the natal cleft, but also in the interdigital spaces of hairdressers • Relatively common, M:F = 4:1, age 20-29 • Occurs in hirsuite men, hair fragments massaged in by sitting/driving occupations

  7. Presentations: • Abscess • Sinus • Recurrence • Management: • Abscess: incision + drainage, packing • Sinus: wide excision ± primary closure • Shaving

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