Perianal – Perirektal Apse ve Fistüller
Özet
Perianal ve perirektal apseler, tıbbi pratikte sık karşılaşılan, anal kriptlerdeki glandüler yapıların tıkanmasıyla başlayan ve tedavi edilmediğinde ciddi doku yıkımı ile sepsise yol açabilen yüksek morbidite ile seyreden inflamatuar süreçlerdir. Genellikle kriptoglandüler teori ile açıklanan bu patolojilerde, enfeksiyonun anatomik boşluklar boyunca yayılması sonucu perianal, iskiorektal veya supralevator apseler gelişmekte, cerrahi drenaj sonrası hastaların yaklaşık %30-50'sinde ise kronikleşen bir süreç olarak anorektal fistüller ortaya çıkmaktadır. Erkeklerde kadınlara oranla iki kat daha fazla görülen bu durumlarda; sigara kullanımı, diyabet ve Crohn hastalığı gibi durumlar önemli risk faktörleri arasında yer almaktadır. Başarılı bir tedavi için Parks sınıflamasına göre fistül traktının doğru tanımlanması ve özellikle manyetik rezonans görüntüleme (MR) gibi ileri radyolojik yöntemlerin preoperatif planlamada kullanılması büyük önem taşımaktadır. Tedavinin temel prensibini ise antibiyoterapi ve cerrahi oluşturmaktadır.
Perianal and perirectal abscesses are inflammatory processes with high morbidity frequently encountered in medical practice. They begin with the obstruction of glandular structures in the anal crypts and, if left untreated, can lead to severe tissue destruction and sepsis. In these pathologies, which are generally explained by the cryptoglandular theory, perianal, ischiorectal, or supralevator abscesses develop as a result of the infection spreading along anatomical spaces. Following surgical drainage, anorectal fistulas emerge as a chronic process in approximately 30-50% of patients. In these conditions, which are twice as common in men as in women, factors such as smoking, diabetes, and Crohn's disease are among the significant risk factors. For successful treatment, the accurate identification of the fistula tract according to the Parks classification and the use of radiological methods, particularly Magnetic Resonance Imaging (MRI), in preoperative planning are of great importance. The fundamental principles of treatment consist of antibiotic therapy and surgery.
Referanslar
Choi YS, Kim DS, Lee DH, Lee JB, Lee EJ, Lee SD, et al. Clinical Characteristics and Incidence of Perianal Diseases in Patients With Ulcerative Colitis. Annals of coloproctology. 2018;34(3):138-43.
Sahnan K, Adegbola SO, Tozer PJ, Watfah J, Phillips RK. Perianal abscess. BMJ (Clinical research ed). 2017;356:j475.
Detry R. [Classification and diagnosis of anal fistulas]. Acta chirurgica Belgica. 1985;85(5):313-7.
Mahmoud NN, Halwani Y, Montbrun S, Shah PM, Hedrick TL, Rashid F, et al. Current management of perianal Crohn's disease. Current problems in surgery. 2017;54(5):262-98.
Sneider EB, Maykel JA. Anal Abscess and Fistula. Gastroenterology Clinics of North America. 2013;42(4):773-84.
Adamo K, Sandblom G, Brännström F, Strigård K. Prevalence and recurrence rate of perianal abscess--a population-based study, Sweden 1997-2009. International journal of colorectal disease. 2016;31(3):669-73.
Eisenhammer S. The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular (Intersphincteric) fistulous abscess and fistula. Diseases of the Colon & Rectum. 1978;21(4):237-54.
Deen-Molenaar CH, Jordanov T, Felt-Bersma RJ. Intersphincteric infection due to an anal fissure. International journal of colorectal disease. 2016;31(3):727-8.
Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T. German S3 guideline: anal abscess. International journal of colorectal disease. 2012;27(6):831-7.
Bakir QK, Noori IF, Noori AF. Accuracy prediction of Goodsall's rule for anal fistulas of crypotogladular origin, is still standing? Annals of medicine and surgery (2012). 2024;86(5):2453-7.
Conner JN, Eren S, Tuma F. Perianal Abscess. StatPearls: StatPearls Publishing LLC.; 2025.
Zincircioğlu Ç, Rollas K, Güldoğan IK, Sarıtaş A, Özkarakaş H, Ersan G, et al. Diagnostic value of procalcitonin and C reactive protein for infection and sepsis in elderly patients. Turkish journal of medical sciences. 2021;51(5):2649-56.
Fritzsche C, Loebermann M, Lampe H, Reisinger EC. It Began with a Suspected Abscess. The American Journal of Medicine. 2010;123(2):e9-e10.
Cox DRA, Rao A, Ee E. Syphilis as an atypical cause of perianal fissure. Journal of surgical case reports. 2018;2018(11):rjy320.
Visscher AP, Felt-Bersma RJ. Endoanal ultrasound in perianal fistulae and abscesses. Ultrasound quarterly. 2015;31(2):130-7.
Balcı S, Onur MR, Karaosmanoğlu AD, Karçaaltıncaba M, Akata D, Konan A, et al. MRI evaluation of anal and perianal diseases. Diagnostic and interventional radiology (Ankara, Turkey). 2019;25(1):21-7.
Sun Y, Bai H, Qu J, Liu J, Wang J, Du Z, et al. Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report. Gut pathogens. 2021;13(1):61.
Jeje AE, Mofikoya BO, Oliyide AE. Fournier's gangrene and perianal abscess: Is there a common denominator? Journal of Clinical Sciences. 2017;14(1).
Zhu Q-B, Zhang J, Liu C-Y, Ye H, Huang S-P, Xue Y-H. Case report of squamous cell carcinoma secondary to recurrent anal fistula. Frontiers in Oncology. 2025;Volume 15 - 2025.
Mocanu V, Dang JT, Ladak F, Tian C, Wang H, Birch DW, et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis. American journal of surgery. 2019;217(5):910-7.
Peri-anal abscess: NHS Scotland; [updated 2024 Sep 12. Available from: https://www.rightdecisions.scot.nhs.uk/antimicrobial-prescribing-nhs-lothian/body-systems/abdominal-infections/surgical-intra-abdominal-infections/peri-anal-abscess/.
Gottlieb M, DeMott JM, Hallock M, Peksa GD. Systemic Antibiotics for the Treatment of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-Analysis. Annals of emergency medicine. 2019;73(1):8-16.
Seow-En I, Ngu J. Routine operative swab cultures and post-operative antibiotic use for uncomplicated perianal abscesses are unnecessary. ANZ journal of surgery. 2017;87(5):356-9.
Severe soft tissue infection including suspected necrotising fasciitis and Fournier's gangrene: NHS Scotland; [updated 2024 Nov 1. Available from: https://www.rightdecisions.scot.nhs.uk/antimicrobial-prescribing-nhs-lothian/body-systems/skin-and-soft-tissue-infections/severe-soft-tissue-infection-including-suspected-necrotising-fasciitis-and-fourniers-gangrene/.
Amato A, Bottini C, De Nardi P, Giamundo P, Lauretta A, Realis Luc A, et al. Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Techniques in Coloproctology. 2020;24(2):127-43.
Referanslar
Choi YS, Kim DS, Lee DH, Lee JB, Lee EJ, Lee SD, et al. Clinical Characteristics and Incidence of Perianal Diseases in Patients With Ulcerative Colitis. Annals of coloproctology. 2018;34(3):138-43.
Sahnan K, Adegbola SO, Tozer PJ, Watfah J, Phillips RK. Perianal abscess. BMJ (Clinical research ed). 2017;356:j475.
Detry R. [Classification and diagnosis of anal fistulas]. Acta chirurgica Belgica. 1985;85(5):313-7.
Mahmoud NN, Halwani Y, Montbrun S, Shah PM, Hedrick TL, Rashid F, et al. Current management of perianal Crohn's disease. Current problems in surgery. 2017;54(5):262-98.
Sneider EB, Maykel JA. Anal Abscess and Fistula. Gastroenterology Clinics of North America. 2013;42(4):773-84.
Adamo K, Sandblom G, Brännström F, Strigård K. Prevalence and recurrence rate of perianal abscess--a population-based study, Sweden 1997-2009. International journal of colorectal disease. 2016;31(3):669-73.
Eisenhammer S. The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular (Intersphincteric) fistulous abscess and fistula. Diseases of the Colon & Rectum. 1978;21(4):237-54.
Deen-Molenaar CH, Jordanov T, Felt-Bersma RJ. Intersphincteric infection due to an anal fissure. International journal of colorectal disease. 2016;31(3):727-8.
Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T. German S3 guideline: anal abscess. International journal of colorectal disease. 2012;27(6):831-7.
Bakir QK, Noori IF, Noori AF. Accuracy prediction of Goodsall's rule for anal fistulas of crypotogladular origin, is still standing? Annals of medicine and surgery (2012). 2024;86(5):2453-7.
Conner JN, Eren S, Tuma F. Perianal Abscess. StatPearls: StatPearls Publishing LLC.; 2025.
Zincircioğlu Ç, Rollas K, Güldoğan IK, Sarıtaş A, Özkarakaş H, Ersan G, et al. Diagnostic value of procalcitonin and C reactive protein for infection and sepsis in elderly patients. Turkish journal of medical sciences. 2021;51(5):2649-56.
Fritzsche C, Loebermann M, Lampe H, Reisinger EC. It Began with a Suspected Abscess. The American Journal of Medicine. 2010;123(2):e9-e10.
Cox DRA, Rao A, Ee E. Syphilis as an atypical cause of perianal fissure. Journal of surgical case reports. 2018;2018(11):rjy320.
Visscher AP, Felt-Bersma RJ. Endoanal ultrasound in perianal fistulae and abscesses. Ultrasound quarterly. 2015;31(2):130-7.
Balcı S, Onur MR, Karaosmanoğlu AD, Karçaaltıncaba M, Akata D, Konan A, et al. MRI evaluation of anal and perianal diseases. Diagnostic and interventional radiology (Ankara, Turkey). 2019;25(1):21-7.
Sun Y, Bai H, Qu J, Liu J, Wang J, Du Z, et al. Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report. Gut pathogens. 2021;13(1):61.
Jeje AE, Mofikoya BO, Oliyide AE. Fournier's gangrene and perianal abscess: Is there a common denominator? Journal of Clinical Sciences. 2017;14(1).
Zhu Q-B, Zhang J, Liu C-Y, Ye H, Huang S-P, Xue Y-H. Case report of squamous cell carcinoma secondary to recurrent anal fistula. Frontiers in Oncology. 2025;Volume 15 - 2025.
Mocanu V, Dang JT, Ladak F, Tian C, Wang H, Birch DW, et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis. American journal of surgery. 2019;217(5):910-7.
Peri-anal abscess: NHS Scotland; [updated 2024 Sep 12. Available from: https://www.rightdecisions.scot.nhs.uk/antimicrobial-prescribing-nhs-lothian/body-systems/abdominal-infections/surgical-intra-abdominal-infections/peri-anal-abscess/.
Gottlieb M, DeMott JM, Hallock M, Peksa GD. Systemic Antibiotics for the Treatment of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-Analysis. Annals of emergency medicine. 2019;73(1):8-16.
Seow-En I, Ngu J. Routine operative swab cultures and post-operative antibiotic use for uncomplicated perianal abscesses are unnecessary. ANZ journal of surgery. 2017;87(5):356-9.
Severe soft tissue infection including suspected necrotising fasciitis and Fournier's gangrene: NHS Scotland; [updated 2024 Nov 1. Available from: https://www.rightdecisions.scot.nhs.uk/antimicrobial-prescribing-nhs-lothian/body-systems/skin-and-soft-tissue-infections/severe-soft-tissue-infection-including-suspected-necrotising-fasciitis-and-fourniers-gangrene/.
Amato A, Bottini C, De Nardi P, Giamundo P, Lauretta A, Realis Luc A, et al. Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Techniques in Coloproctology. 2020;24(2):127-43.
