102011101030 SMF Bedah RSD. dr. Soebandi Jember Fakultas Kedokteran Universitas Jember 2014 REFERAT Pembimbing : dr. Adi Nugroho, Sp.B
ANATOMI DEFINISI Infeksi jaringan lunak di sekitar kanalis analis, disertai dengan pembentukan rongga abses. EPIDEMIOLOGI Abses anorektal dan fistula terjadi pada dekade 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) ETIOLOGI Nonspecific : Cryptoglandular in origin.
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. Patofisiologi Cont A = Infeksi dari usus menyerang kriptus analis atau kelenjar analis lain. Proses primer ini terjadi pada linea dentata . B & C = Infeksi menyebar ke jaringan perianal dan perirektal secara tidak langsung melalui system limfatik atau secara langsung melalui struktur kelenjar. D = Terbentuk abses E = Abses pecah spontan, menorehkan lubang pada permukaan kulit perianal dan terbentuk fistula komplit F = Fistula
(Hamadani et al, 2009) KLASIFIKASI ABSES Initial Evaluation of Perianal Abscess and Fistula-in-Ano (American Society of Colon and Rectal Surgeons,2005) Disease-specific history and physical examination should be performed Emphasizing on: Symptoms Risk factors Location Presence of secondary cellulitis Presence of fistula-in-ano It is important to distinguish anorectal abscess from other perianal 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)
DIAGNOSIS Clinical presentation Abscess 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 DIAGNOSIS BANDING Fissura anal Thrombosis Hemoroid Fistula anal PEMERIKSAAN PENUNJANG MRI EUS CT Scan EUA TERAPI Treatment Abscess 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
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)
Insisi dan drainase abses KOMPLIKASI Setelah dilakukan drainage abses, 37% sampai 50% pada pasien akan berkembang menjadi Abses reccurent atau fistula anal.(Fazio V, 1987)