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S3-Leitlinie: Analabszess

AWMF-Registriernummer: 088/005

S3 guidelines: anal abscess

The German Association of Scientific Medical Societies registration number: 088/005

  • Leitlinien
  • Published:
coloproctology Aims and scope

Zusammenfassung

Hintergrund

Analabszesse sind relativ häufig und treten bevorzugt bei jungen männlichen Erwachsenen auf.

Methode

Es wurde ein systematisches Review der Literatur vorgenommen.

Ergebnisse

Den Ursprung des Abszesses bilden i. d. R. die Proktodealdrüsen des Intersphinkterraumes. Es wird zwischen subanodermalen, intersphinkteren, ischioanalen und supralevatorischen Abszessen unterschieden. In der Diagnostik sind die Anamnese und die klinische Untersuchung für die Operationsindikation als ausreichend anzusehen. Weiterführende Untersuchungen (Endosonographie, Magnetresonanztomographie) sollten bei Rezidivabszessen oder supralevatorischen Abszessen erwogen werden. Der Zeitpunkt der operativen Intervention wird v. a. durch die Symptomatik bestimmt, wobei der akute Abszess grundsätzlich eine Notfallindikation darstellt. Die Therapie des Analabszesses erfolgt operativ, wobei die Wahl des Zugangs (transrektal oder perianal) von der Abszesslokalisation abhängt. Ziel der Operation ist eine großzügige Drainage des Infektionsherdes unter Schonung der Schließmuskelstrukturen. Die Wunde sollte regelmäßig gespült werden (Ausduschen mit Leitungswasser). Die Anwendung von lokalen Antiseptika birgt die Gefahr der Zytotoxizität. Eine Antibiotikatherapie ist nur in Ausnahmefällen erforderlich. Eine intraoperative Fistelsuche sollte allenfalls sehr vorsichtig erfolgen, ein Fistelnachweis nicht erzwungen werden. Das Risiko einer Re-Abszedierung oder sekundären Fistelbildung ist insgesamt gering; die Ursache kann in einer unzureichenden Drainage bestehen. Eine primäre Fistelspaltung soll nur bei oberflächlichen Fisteln durch einen erfahrenen Operateur erfolgen. Bei unklaren Befunden oder hohen Fisteln soll die Sanierung in einem Zweiteingriff erfolgen.

Schlussfolgerung

In diesen klinischen S3-Leitlinien werden erstmals in Deutschland Richtlinien für die Diagnostik und Therapie des anorektalen Abszesses vorgestellt.

Abstract

Background

Anal abscesses are relatively frequent and most common in young men.

Methods

A systematic review of the literature has been undertaken.

Results

The origin of the abscess is usually the proctodeal gland in the intersphincteric space. There are different types of abscesses: intersphincteric, ischioanal and supralevatory abscesses. Anamnesis and clinical examination are sufficient to indicate surgery. Further examinations such as endosonography or magnetic resonance tomography (MRT) should be considered in recurrent or supralevatory abscesses. The timing of surgical intervention depends on clinical symptoms, whereas the acute abscess is an emergency indication. Surgery is the primary therapy approach for anal abscess. Surgical access (transrectal or perianal) depends on the localization of the abscess. The aim of surgery is to broadly drain the infection and protect anal sphincter structures. The wound should be rinsed regularly (showering with clear water). Treatment with local antiseptics carries the risk of zytotoxicity. Antibiotic treatment is necessary only in selected cases. Any attempt to locate a fistula intraoperatively should be undertaken with great care; proven evidence of a fistula is not mandatory. Although the risk of recurrent abscess or secondary fistula is low, these may be caused by insufficient drainage. The primary fistulotomy of superficial fistulas should only be performed by an experienced surgeon. In the case of ambiguous findings or high fistulas, treatment should be carried out in a second surgical procedure.

Conclusion

For the first time in Germany, this clinical S3 guideline provides instructions for the diagnosis and treatment of anal abscesses based on a systematic review of the literature.

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  1. End- und Dickdarmpraxis Essen, Rüttenscheider Str. 66, 45130, Essen, Deutschland

    A. Ommer, A. Herold, E. Berg, S. Farke, A. Fürst, F. Hetzer, A. Köhler, S. Post, R. Ruppert, M. Sailer, T. Schiedeck, B. Strittmatter, B.H. Lenhard, W. Bader, J.E. Gschwend, H. Krammer & E. Stange

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Correspondence to A. Ommer.

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Ommer, A., Herold, A., Berg, E. et al. S3-Leitlinie: Analabszess. coloproctology 33, 378–392 (2011). https://doi.org/10.1007/s00053-011-0225-9

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