Anal gland abscess failing to heal

RE: Anal gland abscess failing to heal

Lindsey Edwards — Fri, 02 Sep 2016 19:13:19 GMT

+1 Bepanthen + clindamycin, flush with saline (non-sterile if available, already contaminated, with or without povisone iodine slow to use chlorhexidine on mucosa) plus ear prep of choice, osurnia interesting idea!

Once clean or in recurrent cases marsupialise duct to prevent blockage in future (personally never remove glands)

RE: Anal gland abscess failing to heal

Aine Seavers — Fri, 02 Sep 2016 02:02:18 GMT

That's interesting to know as we too loved Panalog and miss it so great tip.

Re this case, swab it, but hold off removal-operating into that area with an abscess could make things worse.

I too would take bloods and look for calcium and other markers. (What is the state of the mouth and teeth-read a paper abstract some years back where it stated that the bacteria in the mouth determined the bacteria in the anal sacs-often now with chronic anal sac issues where I would add gluten free fibre and or change the diet to zd, I check the teeth as well and advise dental care as well-not totally convinced but if they are under to be flushed then as both 'dirty' surgeries we will do both at same time

I prefer Clindamycin or Flagly for these areas-and for cover you can use topical nappy rash cream-Sudo Crem applied externally as a good barrier cream.

RE: Anal gland abscess failing to heal

Emily Rainbow — Thu, 01 Sep 2016 20:43:39 GMT

We've started instilling osurnia (off licence) with good effect! N=4 or 5 though.

RE: Anal gland abscess failing to heal

Anthony Todd — Thu, 01 Sep 2016 14:59:57 GMT

I repeat, is normal anal gland content sterile?

"Purulent" A/G content, very often accompanied by irritation or scooting, seemed to be corrected, ie normal amount and consistency of content, by discontinued Panalog [magic stuff, with a high triamcinalone content??] and latterly any sort of broad spectrum ear ointment containing steroid. Sorry, after A/G expression.....

I don't remember ever having to remove any A/G after I packed with Panolog although after a time [months or years] the problem sometimes recurred.

Just expressing the thin purulent material didn't seem to give relief so they must be packed with something appropriate.

Never did C/S on A/Gs or A/G abscesses in my life and never had reason to.

PS The OP's case. I think is not a routine A/G abscess though!

RE: Anal gland abscess failing to heal

ChrisBVSc — Thu, 01 Sep 2016 14:21:22 GMT

[quote user="Clive Ansell"]

[quote user="Anthony Todd"]

[quote user="Clive Ansell"]don't want Toddy on my case for unnecessary investigations [/quote]

Sorry, just asking:

Is A/G content sterile or will you always grow something, and probably "nasty"?

Just thinking of where is it and the likelihood of commensals or contaminants.

I do wonder about E.coli in urine's being considered always pathogenic.

[/quote]

A fair comment.

We already know from the OP that this is not resolving as we would like after 3 weeks of antibiotics, and to continue or change antibiotics based on guess work instead of laboratory evidence is poor medicine.

I think it therefore makes perfect sense to take a swab from the area and find out what is growing. There may well be harmless commensals alongside pathogenic bacteria, but C&S should tells what is there and which antibiotics are effective against which organisms. Can only help, is none invasive and inexpensive. It may even be negligent not to take a swab?

[/quote]

Agreed, definitely needs swabbing for culture & sensitivity. I've treated anal gland abscesses before that have turned out to be resistant to fluoroquinolones but sensitive to what may be seen as 'lesser' antibiotics, so resolving this one could be more straightforward than it seems.

RE: Anal gland abscess failing to heal

Clive Ansell — Thu, 01 Sep 2016 13:59:15 GMT

[quote user="Hannah Wynne Richards"] Canaural[/quote]

Do you do that based on pathogens identified in laboratory results?

Do you get client consent for off label usage?

I just lavage with dilute hibiscrub usually

RE: Anal gland abscess failing to heal

Hannah Wynne Richards — Thu, 01 Sep 2016 12:49:04 GMT

Canaural

Wynne

RE: Anal gland abscess failing to heal

Anthony Dennison — Thu, 01 Sep 2016 11:29:37 GMT

Sorry to slightly hijack this thread, but when people flush and pack anal glands, what is your choice on what you instill into the gland?

RE: Anal gland abscess failing to heal

Liz w — Thu, 01 Sep 2016 11:27:27 GMT

Thanks all. I've got it booked in to do a swab for c+s, flush plus biopsy if we feel it can be done safely with further compromising the anal gland.

Regarding steroid use, one of my colleagues wondered about atopica.

RE: Anal gland abscess failing to heal

Clive Ansell — Thu, 01 Sep 2016 10:20:01 GMT

[quote user="Anthony Todd"]

[quote user="Clive Ansell"]don't want Toddy on my case for unnecessary investigations [/quote]

Sorry, just asking:

Is A/G content sterile or will you always grow something, and probably "nasty"?

Just thinking of where is it and the likelihood of commensals or contaminants.

I do wonder about E.coli in urine's being considered always pathogenic.

[/quote]

A fair comment.

RE: Anal gland abscess failing to heal

Anthony Dennison — Thu, 01 Sep 2016 10:05:06 GMT

[quote user="Evelyn Barbour-Hill"]

I would never dream of excising an anal sac from which an abscess had recently been derived. Maybe if the same sac had repeatedly been responsible for abscesses, as a last resort, in which case I would do it at a planned time after all inflammation had subsided.

[/quote]

I referred a dog for anal sac removal (HMO, had read about the potential risk of faecal incontinence so wanted a specialist to do it) and they refused the surgery as the gland was inflamed. Not even an abscess present, but their reasoning was the border between anal sac and normal tissue wasn't as distinct (or something like that).

RE: Anal gland abscess failing to heal

Anthony Todd — Thu, 01 Sep 2016 09:05:50 GMT

[quote user="Clive Ansell"]don't want Toddy on my case for unnecessary investigations [/quote]

Sorry, just asking:

Is A/G content sterile or will you always grow something, and probably "nasty"?

Just thinking of where is it and the likelihood of commensals or contaminants.

I do wonder about E.coli in urine's being considered always pathogenic.

RE: Anal gland abscess failing to heal

Clive Ansell — Thu, 01 Sep 2016 07:58:33 GMT

[quote user="Thomas Johnson"]If you're taking a biopsy for histopathology it might be worth taking another for tissue culture, as you may find there is a different population of bacteria in the deep tissue compared to the surface.[/quote]

Good call.

I was a suggesting a swab only in the first instance - don't want Toddy on my case for unnecessary investigations

RE: Anal gland abscess failing to heal

Thomas Johnson — Wed, 31 Aug 2016 16:29:43 GMT

[quote user="Clive Ansell"]I think a swab for C&S would be useful at this point. After a poor response to 3 weeks of Marbofloxacin, I would want to know what I'm dealing with before embarking on what is likely to be a lengthy and possibly costly course on antibiotics.[/quote]

If you're taking a biopsy for histopathology it might be worth taking another for tissue culture, as you may find there is a different population of bacteria in the deep tissue compared to the surface.

RE: Anal gland abscess failing to heal

Anthony Todd — Wed, 31 Aug 2016 16:19:59 GMT

[quote user="Evelyn Barbour-Hill"]No, but it might be. Neither the OP nor you nor I know the reason for this lesion not healing. What it wants is investigation.[/quote]

I've seen many ruptured anal gland abscesses looking just like like this which have all healed and sometimes been removed subsequently.

The chances of getting relevant cytology in this case must be remote as well as the chances of uneventful healing. [therefore see my previous suggestion]

Advise owners to find a good laundry and carpet cleaner in the meantime.

RE: Anal gland abscess failing to heal

Clive Ansell — Wed, 31 Aug 2016 12:58:11 GMT

[quote user="Hannah Wynne Richards"]I'd try clindamycin..............marbocyl is useless against anaerobes.[/quote]

I think a swab for C&S would be useful at this point. After a poor response to 3 weeks of Marbofloxacin, I would want to know what I'm dealing with before embarking on what is likely to be a lengthy and possibly costly course on antibiotics.

I had a similar case in a GSD about a year ago, an anal gland abscess not furunculosis. it had been on antibiotics for about 6 weeks and had had Amox/clav, Baytril and Cephalexin. A swab for C&S pointed us in the direction of TMS, a month's course and I was all sorted out.

RE: Anal gland abscess failing to heal

Hannah Wynne Richards — Wed, 31 Aug 2016 08:37:46 GMT

I'd try clindamycin..............marbocyl is useless against anaerobes.

Wynne

RE: Anal gland abscess failing to heal

Evelyn Barbour-Hill — Wed, 31 Aug 2016 01:30:33 GMT

[quote user="Anthony Todd"]Which makes the likelihood of secretory AG tissue being present and active I would think almost certain. Often AG abscesses heal and the AG just continues to be a functioning AG....[/quote]

Sure. What of it? This would only be the cause of the non-healing lesion if it were continuing to leak sac contents into the tissues.

[quote user="Anthony Todd"]I'd be really surprised if it's neoplastic[/quote]

No, but it might be. Neither the OP nor you nor I know the reason for this lesion not healing. What it wants is investigation.

RE: Anal gland abscess failing to heal

David Mills — Wed, 31 Aug 2016 01:26:23 GMT

Most non-healing AG "abscesses" I believe are due to the immune-mediated reaction to AG contents under the skin.

This dog, if I saw it, would not be GA'd until a decent dose of steroids had been given.

Give it a week on roids of choice, 1mg/kg. If no better, then explore.

(I am on holiday and quite relaxed. Even so astounded that Toddy hasn't suggested this.)

RE: Anal gland abscess failing to heal

Anthony Todd — Tue, 30 Aug 2016 23:35:48 GMT

[quote user="Thomas Johnson"]There's no mention in the OP of it having had its anal sacs removed.[/quote]

Which makes the likelihood of secretory AG tissue being present and active I would think almost certain. Often AG abscesses heal and the AG just continues to be a functioning AG....

I'd be really surprised if it's neoplastic and daily boiled saline irrigation [in the garden] with a syringe and a bit of drip tubing would be my initial approach. Review weekly.

RE: Anal gland abscess failing to heal

grumpyoldman — Tue, 30 Aug 2016 22:49:06 GMT

Better to remove it ,good light and a loupe will help and your not going to be able to fill it with gel but you could inject tattoo ink into the duct and let it stain the contact areas which will outline its extent before it all gets bloody and messy. Not easy though.

RE: Anal gland abscess failing to heal

cathal rafferty — Tue, 30 Aug 2016 21:36:11 GMT

I would agree that biopsy is indicated when any wound doesn't heal as expected. I think the essential thing with anal gland abscesses is to ensure the duct of the gland is flushed open, with or without a cannula. If the secretions can't drain through the duct as they should, they will continue to come out through the sinus tract.

RE: Anal gland abscess failing to heal

Liz w — Tue, 30 Aug 2016 18:58:27 GMT

Yes, just to clarify, it hasn't had its anal sacs removed. There's a lot of scar tissue there, which I guess could be neoplastic. Frustratingly the dog seems very comfortable and the owner seems happy with how it's doing.

Re the antibiotics - before marbofloxacin he was on synulox, but he was changed onto marbo care when it was still purulent after a week of synulox.

RE: Anal gland abscess failing to heal

Thomas Johnson — Tue, 30 Aug 2016 18:05:35 GMT

[quote user="John Wessels"]

tract from some AG tissue left behind as Anthony said.

You ll have to find it and remove, otherwise it will stay open.

[/quote]

There's no mention in the OP of it having had its anal sacs removed.

I would probably repeat GA, swab for culture and sensitivity, biopsy for histopath as I agree with Michael that neoplasia is possible, and then flush it copiously. If you can then pack it with something like Surolan I would consider doing that as well.

RE: Anal gland abscess failing to heal

John Wessels — Tue, 30 Aug 2016 17:00:35 GMT

tract from some AG tissue left behind as Anthony said.

You ll have to find it and remove, otherwise it will stay open.