Anorectal abscess

OPERATIONS  FOR ACUTE ANORECTAL ABSCESSES (Rygick’s method)

1. Diagram to show the disposition of acute ano-rectal abscesses

2. Diagram to show the location of a retrorectal abscess

A patient with an acute anorectal abscess must be operated on within a few hours after the establishemcnl of diagnosis. Anoreclal abscesses are usually located in the perirectal or perianal fatty tissues and may be classified, according to their site of origin, into the following four types (Fig. 1: 1, 2 and 3, and Fig. 2):  subcutaneous (perianal), in 50 per cent of patients: (2) is-chiorectal, in 40 per cent (2); (3) pelvirectal, in 8 per cent (1); and (4) retrorectal, in 2 per cent of patients (Fig. 2).  In   anorectal    abscess,   the   internal   opening,(portal of infection) is invariably located in the rectal lumen. (Fig. 3, 4).

3. Schematic representation of a perirectal abscess with its internal opening in a posterior crypt

4. Schematic representation of a perirectal abscess with its internal opening in an anterior crypt

In 55 per cent of cases, it is localized in a posterior crypt of Morgagni, in 35 per cent in an anterior crypt, and only in 10 per cent in a lateral crypt.
If the internal opening is left open an anal fistula will be formed. If it is closed with a weak drawn-in scar the abscess lends to recur. For that reason, the surgeon must not only lay the abscess open but also obliterate its internal opening.

The  operation   for  acute  anorectal   abscess   with   sphincterotomy through the internal  abscess opening  (Rygick’s method)

5.1 The steps in the operation for inschiorectal abscess:One index finger is introduced into the abscess cavity and the other, into the rectum

5.2 The steps in the operation for inschiorectal abscess: Posterior rectal wall is incised 1 cm deep

This method is used in ischiorectal and pelvirectal abscesses. A semilunal incision is made to lay the abscess cavity wide open. The surgeon then introduces his index finger into the abscess cavity, while inserting his other index finger into the rectum (Fig. 5.1). This enables him to readily ascertain which rectal wall the abscess cavity-adjoins, that is, to find out whether its internal opening is situated in a posterior or anterior crypt. Next, a rectal speculum is passed into the rectal lumen and a posterior (or anterior) sphinclerolorny performed through the internal opening of the abscess (Fig. 5.2).

5.3 The steps in the operation for inschiorectal abscess: An ointment pack and tubing for gas evacuation have been inserted into the rectal lumen

5.4 The steps in the operation for inschiorectal abscess: Linear scar of the rectal wall after sphincterotomy

The rectal wound is packed with gauze soaked in Vishnevsky ointment or in ointment with Peruvian balsam, with insertioi of a rubber tube into the rectal lumen (Fig. 5.3). Th abscess cavity is carefully packed with heavily soake ointment packs. Dressings are applied as in the case c subcutaneous abscess. Opium tincture is given for 8— days. In fermales no sphincteratomy is performed if th abscess adjoins an anterior crypt.
As a result of our operation, a strong linear scar i formed in the rectum at the site of sphincterotom; (Fig. 5.4), which precludes the formation of a fistul. or abscess recurrence.