https://wikem.org/w/index.php?action=history&feed=atom&title=Anorectal_abscess%2FenAnorectal abscess/en - Revision history2026-04-20T02:51:32ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Anorectal_abscess/en&diff=379941&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-06T21:10:31Z<p>Updating to match new version of source page</p>
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==Background==<br />
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[[File:Abscess diag 02.png|thumb|Anorectal abscess types and their locations.]]<br />
*Usually begin via blocked anal gland (leads to infection/[[Special:MyLanguage/abscess|abscess]] formation)<br />
**Can progress to involve any of the potential spaces.<br />
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{| {{table}}<br />
| align="center" style="background:#f0f0f0;"|''' '''<br />
| align="center" style="background:#f0f0f0;"|'''Perianal'''<br />
| align="center" style="background:#f0f0f0;"|'''Ischiorectal'''<br />
| align="center" style="background:#f0f0f0;"|'''Intersphincteric, deep postanal, pelvirectal'''<br />
|-<br />
| '''Epidemiology'''||Most common||Second most common||Least common<br />
|-<br />
| '''Symptoms'''||Located close to anal verge, posterior midline, superficial tender mass||Larger, indurated, well-circumscribed, located laterally on medial aspect of buttocks||Rectal pain, skin signs may not be present<br />
|-<br />
| '''Comments'''||High incidence of [[Special:MyLanguage/anal fistula|fistula]] formation even with drainage||||Constitutional symptoms often present<br />
|}<br />
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===Risk Factors===<br />
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*[[Special:MyLanguage/Crohn's disease|Crohn's disease]]<br />
*Chronic [[Special:MyLanguage/constipation|constipation]]<br />
*[[Special:MyLanguage/Diabetes mellitus|Diabetes mellitus]]<br />
*Chronic [[Special:MyLanguage/corticosteroid|corticosteroid]] use<br />
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==Clinical Features==<br />
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[[File:Perianalabscess.jpg|thumb|Perianal abscess.]]<br />
[[File:Perianalabszess 01.jpg|thumb|Perianal abscess.]]<br />
*Worsening pain around bowel movement, with decreased pain post rectal evacuation<br />
*Perirectal abscesses often accompanied by [[Special:MyLanguage/fever|fever]], [[Special:MyLanguage/leukocytosis|leukocytosis]]<br />
**May only be palpable via digital rectal exam<br />
**Perianal abscesses typically do not cause fever in immunocompetent individuals<br />
*Tender inguinal [[Special:MyLanguage/lymphadenopathy|lymphadenopathy]] may be only clue to deeper abscesses<br />
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==Differential Diagnosis==<br />
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{{Anorectal DDX}}<br />
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{{SSTI DDX}}<br />
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==Evaluation==<br />
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*CT with IV contrast can be useful to define deep abscesses (especially with pain out of proportion to exam)<br />
*May consider [[Special:MyLanguage/ultrasound|ultrasound]] or MRI as alternatives<br />
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==Management==<br />
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*Isolated perianal [[Special:MyLanguage/abscess|abscess]] is only type of anorectal [[Special:MyLanguage/abscess|abscess]] that should be treated in ED<br />
**Consider either linear incision with packing, elliptical incision, or cruciate incision without packing<br />
**Frequent sitz baths<br />
*All perirectal abscesses (ischiorectal, intersphincteric, supralevator) should be drained in the OR<br />
*All anorectal abscesses require surgical referral and follow up<br />
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===Antibiotics===<br />
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''Causative organisms: Mixed infection with fecal flora for [[Special:MyLanguage/anaerobes|anaerobes]] and [[Special:MyLanguage/Gram Negatives|Gram Negatives]] ([[Special:MyLanguage/Bacteroides fragilis|Bacteroides fragilis]] and [[Special:MyLanguage/Escherichia coli|Escherichia coli]])''<br />
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'''Use is controversial'''<br />
*Only recommended in high risk patients:<ref>BMJ Best Practice Anorectal [[Special:MyLanguage/abscess|abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[Special:MyLanguage/abscess|abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref><br />
**Elderly<br />
**Diabetics<br />
**Systemic signs ([[Special:MyLanguage/fever|fever]], [[Special:MyLanguage/leukocytosis|leukocytosis]])<br />
**[[Special:MyLanguage/Valvular heart disease|Valvular heart disease]]<br />
**[[Special:MyLanguage/Cellulitis|Cellulitis]]<br />
**Immunosuppression<br />
*Possibly prevent [[Special:MyLanguage/anal fistula|fistula]] formation in otherwise healthy patients<ref>Mocanu V, Dang JT, Ladak F, et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis. Am J Surg. 2019;217(5):910-917.</ref><br />
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'''Treatment options:'''<br />
*[[Special:MyLanguage/Augmentin|Augmentin]]<br />
*[[Special:MyLanguage/Ciprofloxacin|Ciprofloxacin]] 500mg PO BID '''and''' [[Special:MyLanguage/Metronidazole|Metronidazole]] 500mg PO TID<br />
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==Disposition==<br />
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===Discharge===<br />
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*Perianal abscess<br />
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==See Also==<br />
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*[[Special:MyLanguage/Anorectal Disorders|Anorectal Disorders]]<br />
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==External Links==<br />
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*[http://vimeo.com/59270692 Rob Orman Lecture]<br />
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==References==<br />
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<references/><br />
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[[Category:GI]]</div>FuzzyBot