REFERAT PERIANAL ABSES
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5/22/2018 REFERAT PERIANAL ABSES
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PERIANAL ABSES
Senoadji Pratama, S.Ked
102011101030
SMF Bedah RSD. dr. Soebandi Jember
Fakultas Kedokteran Universitas Jember2014
REFERAT
Pembimbing :
dr. Adi Nugroho, Sp.B
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ANATOMI
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DEFINISI
Infeksi jaringan lunak di sekitar kanalisanalis, disertai dengan pembentukan
rongga abses.
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EPIDEMIOLOGI
Abses anorektal dan fistula terjadi padadekade 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)
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ETIOLOGI
Nonspecific :
Cryptoglandular in origin.
Specific :
CrohnsUlcerative colitis
TB
Carcinoma, Lymphoma, Leukemia
Trauma
Pelvic inflammation
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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.
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Patofisiologi Cont
A = Infeksi dari usus menyerang kriptus
analis atau kelenjar analis lain. Prosesprimer ini terjadi pada linea dentata .
B & C = Infeksi menyebar ke jaringan perianaldan perirektal secara tidak langsungmelalui system limfatik atau secaralangsung melalui struktur kelenjar.
D = Terbentuk abses
E = Abses pecah spontan, menorehkanlubang pada permukaan kulit perianaldan terbentuk fistula komplit
F = Fistula
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PENYEBARAN ABSES
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Penyebaran abses cont
Dari 1000 pasien yang didiagnosis anorektalabses, terdapat:
1. Perianal abses 42,7 %,
2. Ischiorektal 22,7 % ,3. Intersfingter 21,4%
4. Supralevator 7,33% .
(Hamadani et al, 2009)
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KLASIFIKASI ABSES
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Initial Evaluation of Perianal Abscess and
Fistula-in-Ano(American Society of Colon and Rectal Surgeons,2005)
Disease-specific history and physical examination should beperformed
Emphasizing on: Symptoms
Risk factors
Location Presence of secondary cellulitis
Presence of fistula-in-ano
It is important to distinguish anorectal abscess from otherperianal 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)
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DIAGNOSIS
Clinical presentationAbscess
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
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DIAGNOSIS BANDING
Fissura anal Thrombosis Hemoroid
Fistula anal
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PEMERIKSAAN PENUNJANG
MRI
EUS
CT Scan
EUA
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TERAPI
TreatmentAbscess
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
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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)
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Insisi dan drainase abses
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KOMPLIKASI
Setelah dilakukan drainage abses, 37% sampai 50%
pada pasien akan berkembang menjadi Abses
reccurent atau fistula anal.(Fazio V, 1987)
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