Résumé
Les abcès anopérinéaux sont un motif de consultation urgent fréquent. Les examens complémentaires sont exceptionnellement utiles et l’examen clinique seul permet le plus souvent de poser le diagnostic positif. En urgence, l’incision de l’abcès est le geste essentiel visant à soulager la douleur du malade et limiter la diffusion de l’infection. En revanche, les antibiotiques n’ont pas de place, du moins seuls, pour traiter ce type de suppuration. Ils ne sont indiqués, après incision, que dans certaines situations particulières chez des patients fragiles ou en cas de cellulite. La prescription antalgique d’anti-inflammatoire non stéroïdien est contre-indiquée en raison du sur-risque de cellulite nécrosante. La prise en charge chirurgicale urgente, au bloc opératoire, sous anesthésie générale, n’a de place que chez un patient non soulagé par l’incision simple, qu’en cas d’abcès profond inaccessible ou de cellulite. Après incision, et au mieux dans la semaine qui suit, le patient est adressé pour une consultation spécialisée de proctologie afin de décider de la prise en charge thérapeutique étiologique qui reste dominée par les fistules cryptoglandulaires.
Abstract
Perianal abscesses are a frequent reason for emergency consultation. Additional tests are rarely needed, and clinical examination is usually sufficient to allow a positive diagnosis. In emergency situations, incision of the abscess is the main procedure used to relieve the patient’s pain, and prevent the infection from spreading. Conversely, antibiotics have no place, at least on their own, in the treatment of this type of suppuration. They are indicated, following incision, in only certain specific situations involving delicate patients, or in case of cellulitis. Prescription of non-steroidal anti-inflammatory analgesics is contraindicated because of the increased risk of necrotising cellulitis. Emergency surgical treatment under general anaesthetic is useful only in patients who do not obtain relief from incision, or in case the abscess is deep and inaccessible or in case of cellulitis. After incision, and ideally during the following week, the patient is referred for a consultation with a specialist in proctology in order to determine the aetiological therapeutic management, which is still largely decided as a function of the cryptoglandular fistulas.
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Fathallah, N., Ravaux, A., de Parades, V. et al. Conduite à tenir face à un abcès anopérinéal. Ann. Fr. Med. Urgence 7, 174–182 (2017). https://doi.org/10.1007/s13341-017-0759-8
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DOI: https://doi.org/10.1007/s13341-017-0759-8