Anorectal abscess

Question 1

Anorectal abscesses are more common in

Answer 1

middle-aged males

Question 2

Anorectal abscesses begin with

Answer 2

involvement of an anal crypt and its gland

Question 3

Most common anorectal abscess location is

Answer 3

Perianal
- located close to the anal verge, often posterior midline
- superficial tender mass that may or may not be fluctuant

Question 4

2nd most common location of anorectal abscess

Answer 4

Ischiorectal abscess
- tend to be larger, indurated, and well-circumscribed
- located more laterally on the medial aspect of the buttocks

Question 5

Least common anorectal abscess location is

Answer 5

Supralavator (pelvirectal)

Question 6

Remarks on postanal abscess

Answer 6

may not manifest cutaneous signs, but rectal pain and tenderness are invariably present

Question 7

generally the only type of rectal abscess that can be adequately treated in the ED

Answer 7

Isolated perianal abscesses

Surgical referral [as outpatient] after drainage is suggested because fistula formation is not uncommon

Question 8

Remarks on ischiorectal abscesses

Answer 8

“Horseshoe abscess”

Can be problematic and complicated as the ischiorectal fossa forms a large potential space on either side of the rectum, communicating behind it through the deep postanal space

Question 9

Remarks on perirectal abscesses

Answer 9

often associated with constitutional symptoms

if complicated abscess is suspected, obtain CT or MRI

All perirectal abscesses should be drained in the OR.

Question 10

Pain of anorectal abscesses

Answer 10

Pain worse immediately before defecation, is lessened after defecation, but persists between bowel movements

Pain is exacerbated by movement and sitting

Question 11

Painful on rectal examination and are lateral to the anal verge

Answer 11

ischiorectal abscess

Question 12

a tender mass may be palpable on DRE of the rectal canal, often in the posterior midline

Answer 12

intersphincteric abscess
- pain is also aggravated by straining or coughing

Intersphincteric abscess encircling the rectum (Garg, 2019)

Question 13

may be palpable on vaginal examination

Answer 13

Supralavator (pelvirectal) abscesses

Question 14

often a clue to deeper abscesses

Answer 14

tender inguinal adenopathyT

Question 15

Techniques in draining isolated perianal abscess

Answer 15

1. Anesthesize with lidocaine with epinephrine
2. Linear or cruciate incision
3. Trimming the flaps is suggested to prevent closure, and packing is not required

Question 16

Wound care post-drainage

Answer 16

Cover the wound with a bulky dressing

and have the patient take frequent warm baths starting the next day

antibiotics are not necessary after adequate drainage in healthy patients

24-hour follow up is recommended

Question 17

Indications for admission

Answer 17

Fever
Leukocytosis
Cellulitis

Diabetes
Immunosuppression
Valvular heart disease
Elderly

FaLCo, DIVE!

Question 18

Antibiotics for complicated anorectal abscess

Answer 18

Broad-spectrum antibiotics (e.g., pip-taz IV)

provide tetanus prophylaxis as needed