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Anorectal Abscesses: ED Clinical Presentation, Evaluation, and Management

Anorectal complaints are a common presentation in the Emergency Department. While significantly less common than hemorrhoids, there are an estimated 68,000 to 96,000 cases of anorectal abscesses per year in the United States. This number is thought to be grossly underestimated by the misdiagnosis of abscesses as hemorrhoids by both patients and clinicians. Although the diagnosis would seem straightforward, one study found that only 50% of physicians diagnosed anorectal conditions accurately, suggesting that there is a need for better understanding of the history and clinical findings associated with these conditions. If not correctly diagnosed and drained, anorectal abscesses can progress…

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 The Bottom Line 2: Anorectal abscess & Fournier’s Gangrene

Pain on DRE or high clinical suspicion should trigger advanced imaging. Unfortunately, imaging test characteristics are not well delineated in the literature. The American Society of Colon and Rectal Surgery (ASCR) recommends CT with contrast, followed by MRI for a negative scan with high suspicion, but the evidence cited in guidelines is not idea

 The Low Down on Ano-Rectal Disorders

Emergency physicians are often uncertain about when and how to drain perianal abscesses. We worry about abscesses being too deep and beyond our scope of practice. Although there are many complex terms and designations for abscesses in the various potential spaces of the ano-rectal region, a simple rectal examination can usually determine if an abscess requires surgical referral for drainage. Severe pain or fluctuance ascending proximally along the ano-rectal canal should alert the clinician to the presence of a deeper (perirectal) abscess. Perirectal abscesses are best drained in the operating room under general anesthesia. In some instances, these also involve other abnormalities, such as fistulae, which also require surgical repair.

Articles of Interest

Anorectal Infection: Abscess–Fistula

Anorectal abscess and fistula are among the most common diseases encountered in adults. Abscess and fistula should be considered the acute and chronic phase of the same anorectal infection.

No Butts About it: Approaching Anorectal Abscesses

The most common presentation of an anorectal abscess is pain in the perianal region, erythema, fluctuance, and swelling. Not all of these may be present. Systemic signs such as high fever, chills, tachycardia, or leukocytosis should warrant a high suspicion for more significant involvement.

The Types of Anorectal Abscesses & What They Mean

The anal glands are in close proximity to a major source of E. coli一 making them highly susceptible to infection by both this and other bacteria commonly found on the skin, like staphylococcus. When the glands become infected, they can swell and close off, building up pus as your body attempts to fight off the infection. Anorectal abscesses must be addressed as soon as possible because they can lead to systemic infections that can become serious very quickly.

Under pressure: Anorectal abscesses… to drain or not to drain?

Key Point #1: Always do a Digital Rectal Exam. Palpate in all directions to localize area of tenderness. Should be unremarkable after you get past the anal verge – if tenderness, mass, induration past anal verge, do a CT scan to assess for deeper abscess.

Urgent care practice in anorectal abscess. Still a pending task

Anorectal abscesses are very frequent in the ED. There is great clinical variability regarding the taking of cultures, prescription of antibiotics, and referral criteria to a specialized coloproctology outpatient department, without clear impact of any of them on the recurrence of the abscess.

What it’s like to live with a fistula – the IBD problem that no one talks about

You might think there’s a quick solution for these types of things but often, patients can live with them for years. Some surgeries can help drain abscesses or open the fistula to heal it, but success rates vary and they often end up recurring.