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Perianal Abscess
Aka: Perianal Abscess
- See Also
- Perirectal Abscess
- Epidemiology
- Represents 60% of Perirectal Abscess
- Pathophysiology
- Local Perirectal Abscess adjacent to anal verge
- Signs
- Superficial tender fluctuant perianal mass
- Immediately adjacent to anal verge
- Abscess limited to perianal subcutaneous tissue
- Digital Rectum exam red flags for deep space infection (consider CT Pelvis and surgery Consultation)
- Significant intolerance to rectal exam (chandelier sign)
- Bogginess, tenderness, induration superior to the anal sphincter (supralevator space)
- Anoscopy
- Fistula opening with drainage
- Associated Conditions
- Fistula-in-ano (50% of cases)
- Differential Diagnosis
- Ischiorectal Abscess (2-3 cm from anal verge)
- Deep Perirectal Abscess
- Management: Incision and Drainage
- See Perirectal Abscess
- Precautions
- Visible abscess (red, swollen pocket) may be drained
- Imaging and surgical Consultation is indicated if the abscess pocket can not easily be seen
- Local Incision and Drainage directed away from Rectum
- Local Anesthetic (marginal efficacy)
- Use 18 gauge needle to localize the abscess pocket
- Localizes site of incision
- Incise into fluctuant area near anal verge
- Avoid incising sphincter
- However place incision close to anal verge (avoids longer tract fistula complications)
- Direct incision in plane radial to anus
- Irrigate abscess cavity with saline
- Ensure continued patent drainage
- Eliptical incision (1 cm long) or
- Insert gauze or penrose drain (Suture in place)
- Management: Surgical Referral Indications
- Failed improvement within 24 hours of drainage
- Signs of abscess extension
- Underlying hematologic disease
- Evaluation at one week for Fistula-in-ano
- Recurrent Perianal Abscess
- Consider underlying causes (Crohn Disease, HIV Infection)
- Follow-up
- Re-examine in 24 hours for improvement
- References
- Jhun and Cologne in Herbert (2015) EM:Rap 15(9): 17-8
- Marx (2002) Rosen's Emergency Medicine, p. 1952
- Roberts (1998) Procedures, Saunders, p. 649-51
- Surrell in Pfenninger (1994) Procedures, Mosby, p. 969
- Cohee (2020) Am Fam Physician 101(1):24-33 [PubMed]