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Anorectal sepsis: microbiology in relation to fistula-in-ano
Abstract:
One hundred and sixty-five patients presented in a 4-year period: 68 (41.2 per cent) had had previous anorectal sepsis and in 56 of these patients (82.3 per cent) the presenting sepsis was at the site of the previous abscess. The abscesses were drained and pus was sent for culture; any fistula, if found, was laid open. A second examination under anaesthesia was performed within 7--10 days if no fistula had been found. The pus from 114 patients grew bowel-derived organisms; 62 (54.4 per cent) fistulas were found. The pus from 34 patients grew skin-derived organisms but no fistula was demonstrated in this group. It is suggested that a second examination need only be performed if culture of the pus grows bowel-derived organisms: anorectal abscesses which grow skin-derived organisms are not associated with a fistula.
Insights
Anorectal abscesses with skin-derived organisms typically do not involve fistulas, suggesting a second examination is unnecessary in these cases. This finding can streamline treatment for recurrent anorectal sepsis.
Area of Science:
- Proctology
- Surgical Infections
- Microbiology
Background:
- Recurrent anorectal sepsis often presents as abscesses.
- Identifying associated fistulas is crucial for effective management.
- Previous infections can complicate diagnosis and treatment.
Purpose of the Study:
- To determine the association between microbial cultures of anorectal abscess pus and the presence of fistulas.
- To evaluate the necessity of a second examination under anesthesia based on culture results.
Main Methods:
- Retrospective analysis of 165 patients with anorectal sepsis over 4 years.
- Abscess drainage with pus culture and fistula assessment.
- Second examination under anesthesia performed selectively if no fistula was initially found.
Main Results:
- Bowel-derived organisms were cultured from 114 patients, with 62 (54.4%) having fistulas.
- Skin-derived organisms were cultured from 34 patients, none of whom demonstrated a fistula.
- Of 68 patients with prior sepsis, 56 presented with recurrence at the same site.
Conclusions:
- Anorectal abscesses yielding skin-derived organisms are unlikely to be associated with fistulas.
- A second examination under anesthesia may be reserved for cases with bowel-derived organisms in abscess pus.
- This approach could optimize the management of recurrent anorectal sepsis.