EMERGENCIES ALL SHOULD KNOW: ABSCESS

 ABSCESS


An abscess is a collection of pus that has accumulated within a tissue because of an inflammatory process in response to either an infection or any foreign material. It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body.

The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.

The cardinal symptoms and signs of any kind of inflammatory process are redness, heat, swelling, pain and loss of function. Abscesses may occur in any kind of solid tissue but most frequently on skin surface  or deep skin , in the lungs, brain, kidneys and liver etc. Major complications are spreading of the abscess material to adjacent or remote tissues and extensive regional tissue death. Abscesses in most parts of the body rarely heal themselves, so prompt medical and surgical attention is needed at the first suspicion of an abscess. An abscess could potentially be fatal (although this is rare) if it compresses vital structures such as the trachea, in the context of a deep neck abscess, or in the brain causing altered sensorium.


Wound abscesses can be treated with antibiotics. They require surgical intervention, in the form of incision and drainage, debridement and curettage under anaesthesia cover. It is important to note that appropriate antibiotic therapy alone without surgical drainage of the abscess is seldom effective.The reason being, antibiotics are unable to get into the abscess and their ineffectiveness at low pH levels. Whilst most medical texts advocate surgical incision some medical doctors will treat small abscesses conservatively with antibiotics.


Perianal abscess:
 Perianal abscess can be seen in patients with for example inflammatory bowel disease  or more commonly in diabetes. Often the abscess will start as an internal wound caused by ulceration, hard stool or penetrative objects with insufficient lubrication. This wound typically becomes infected as a result of the normal presence of feces in the rectal area, and then develops into an abscess. This often presents itself as a lump of tissue near the anus which grows larger and more painful with time. Like other abscesses, perianal abscesses may require prompt medical treatment, such as an incision and debridement and drainage through open wound , allowing it to heal on its own reducing the chances of recurrence.