A prospective survey of patients with anorectal abscesses treated at Cook County Hospital over a 35-month period produced data on 474 patients. The peak incidence was in the third decade of life. Males were affected 1.76 times more frequently than females. Perianal abscess was the most common anatomic type (42 per cent), with ischiorectal abscess (20 per cent) being second. The supralevator space was involved in 7 per cent of the abscesses. Primary fistulotomy was performed when an anal fistula could be demonstrated (34 per cent). Our standardized method of treatment, utilizing radial incisions for drainage, produced satisfactory results with a complication rate of 3 per cent, an in-hospital reoperation rate of 0.6 per cent, and an average hospital stay of 5.7 days.
Changes in anal sphincteric manometric pressures in response to rectal distention were measured in eight patients with chronic anal fissures and were compared with those of ten controls. No statistically different resting pressures were noted between the two groups. Overshoot phenomenon was more commonly seen in patients with fissure. There were no differences in the anal sphincteric pressures after lateral internal sphincterotomy (LIS) or fissurectomy midline sphincterotomy (FMS). All fissures healed postoperatively, irrespective of the surgical technique (LIS or FMS) or the pressure readings. It can be concluded that the therapeutic effect of sphincterotomies might at least in part be due to anatomic widening of the anal canal rather than to decreased resting pressures of the internal sphincter.
Anorectal suppurations are quite common. Supralevator abscesses, previously regarded as a rare subgroup, were seen in 9.1 per cent of 506 patients admitted to Cook County Hospital in a two-year period. Aggressive supportive management was followed by early, adequate drainage through the rectum whenever indicated. When fistulas were identified, either a primary fistulotomy or a two-stage fistulotomy using a seton was performed in the majority of cases. Important factors in the prevention of morbidity and mortality included debridement of all necrotic tissue, careful bacteriologic studies and judicious use of antibiotics, close postoperative observation, and long-term follow-up of the patients.
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