Surgery.

Date:: [1913]

Catalogue details

Licence: In copyright

Credit: Surgery. Source: Wellcome Collection.

246/412 (page 218)

If the abscess be neglected, pus can spread either (a) into the rectum, causing an internal rectal sinus, the opening being near the muco-cutaneous junction ; (b) on to the skin surface, leading to an external rectal sinus ; (c) into the rectum and also on to the skin surface—a fistula-in-ano ; or (d) affects the opposite ischio-rectal fossa—a horse-shoe sinus. What is the Treatment ? The abscess must be incised as soon as possible under general anaesthesia. The incision must be adequate, all recesses of the abscess cavity are opened up, and a pack of flavine or vaseline gauze is inserted. Healing must take place from below lest a fistula supervenes. Describe Pelvi-rectal Abscess. Pelvi-rectal abscesses occupy the space between the levator ani and the muscular tunic of the rectum and they may result from suppuration in the bladder, prostate, broad ligament, uterus, uterine tubes, or from appendicitis or diverticulitis. The pus may rupture into the rectum, through the levator ani into the ischio-rectal fossa or it may point above the inguinal ligament. The symptoms are those of the original lesion and the abscess may be felt above the internal sphincter, its upper limit frequently being out of reach. The abscess may be opened through the ischio-rectal fossa or into the rectum. Give the Pathology of Fistula-in-Ano. Fistula-in-ano, either complete or incomplete, arises from a chronic abscess in the region of the rectum and is frequently tuberculous. The complete fistula most commonly follows an ischio-rectal abscess which has burrowed through the rectal mucosa and also opened upon the skin surface.