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Perianal Abscess

See Also
1. Perirectal Abscess
Epidemiology
1. Represents 60% of Perirectal Abscess
Pathophysiology
1. Local Perirectal Abscess adjacent to anal verge
Signs
1. Superficial tender fluctuant perianal mass
2. Immediately adjacent to anal verge
3. Abscess limited to perianal subcutaneous tissue
4. Anoscopy demonstrates fistula opening with drainage
Associated Conditions
1. Fistula-in-ano (50% of cases)
Differential Diagnosis
1. Ischiorectal Abscess (2-3 cm from anal verge)
Management
1. See Perirectal Abscess
2. Local Incision and Drainage directed away from rectum
  1. Local anesthetic (marginal efficacy)
  2. Incise into fluctuant area near anal verge
  3. Direct incision in plane radial to anus
  4. Irrigate abscess cavity with saline
  5. Insert gauze or penrose drain (Suture in place)
Follow-up
1. Re-examine in 24 hours for improvement
Surgical Referral Indications
1. Failed improvement within 24 hours of drainage
2. Signs of abscess extension
3. Underlying hematologic disease
4. Evaluation at one week for Fistula-in-ano
References
1. Marx (2002) Rosen's Emergency Medicine, p. 1952
2. Roberts (1998) Procedures, Saunders, p. 649-51
3. Surrell in Pfenninger (1994) Procedures, Mosby, p. 969

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.