New Insights into the Pathophysiology and Treatment of the Ischiorectal Abscesses

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  • 坐骨直腸窩膿瘍の病態と切開排膿術

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Abstract

[Pathophysiology] Ischiorectal abscesses typically originate from an infection in a posterior midline anal crypt. The infection subsequently penetrates through the internal sphincter in a dorsocranial direction and extends into the posterior deep space (IIIP), where a primary abscess is formed. A high ischiorectal abscess (IIIHa) is formed when the abscess further extends through the external sphincter at the deeper portion of IIIP, and a low ischiorectal abscess (IIILa) when the shallow portion.<br> [Operation] The aim of the procedure is to drain both the primary and secondary abscesses. An incision is made in the posterior midline approximately 2cm from the anal verge. The primary abscess is drained first by inserting a forceps into IIIPa. The forceps can then be easily advanced into the secondary abscess in IIIHa or IIILa. A drain is placed through IIIPa into the bottom of the secondary abscess.<br> [Results] Abscess drainage via IIIP was possible in all cases of IIIH and IIIL. When limited to cases where this operation was the initial drainage procedure, secondary fistula formation was prevented in as much as 15/24 (62.5%) of the cases. Therefore, this operation helps to shorten and straighten the fistula tract formed after drainage of the ischiorectal abscesses.<br>

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