eMedicine Specialties > General Surgery > Colorectal

Perianal Abscess: Workup

Author: Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Feb 23, 2009

Workup

Laboratory Studies

  • No specific laboratory studies are indicated in the evaluation of a patient with a perianal or anorectal abscess.
  • Certain patients, such as individuals with diabetes and patients who are immunocompromised, are at high risk for developing bacteremia and possibly sepsis, as a result of an anorectal abscess. In such cases, complete laboratory evaluation is important. Laboratory evaluation of the septic patient is not the focus of this article.

Imaging Studies

  • Imaging studies rarely are necessary in the evaluation of patients with an anorectal abscess; however, clinical suspicion of an intersphincteric or supralevator abscess may require confirmation by CT scanning, MRI, or anal ultrasonography.2,3 Use of the last modality is limited to confirming the presence of an intersphincteric abscess.

Diagnostic Procedures

  • Digital examination under anesthesia can be helpful in certain cases, because patient discomfort can significantly limit physical assessment. For example, optimal evaluation for an ischiorectal abscess is performed in this manner.
  • Evidence suggests that the use of endoscopic visualization (transrectal and transanal) is an excellent way to evaluate complex cases of perianal abscess and fistula. With the endoscopic technique, the extent and configuration of the abscess and fistulas can be clearly visualized. The endoscopic visualization has been reported to be as effective as fistulography. In experienced hands, endoscopic evaluation is the preferred diagnostic procedure in patients with perirectal pathology because of the low risk of bacterial dissemination and the low incidence of patient discomfort. Utilizing endoscopic evaluation after nonsurgical treatment is also effective for the documentation of the patient's response to therapy.

More on Perianal Abscess

Overview: Perianal Abscess
Workup: Perianal Abscess
Treatment: Perianal Abscess
Follow-up: Perianal Abscess
Multimedia: Perianal Abscess
References
Further Reading
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References

  1. Novotny NM, Mann MJ, Rescorla FJ. Fistula in ano in infants: who recurs?. Pediatr Surg Int. Nov 2008;24(11):1197-9. [Medline].

  2. Chandwani D, Shih R, Cochrane D. Bedside emergency ultrasonography in the evaluation of a perirectal abscess. Am J Emerg Med. Jul 2004;22(4):315. [Medline].

  3. Tio TL, Mulder CJ, Wijers OB, et al. Endosonography of peri-anal and peri-colorectal fistula and/or abscess in Crohn's disease. Gastrointest Endosc. Jul-Aug 1990;36(4):331-6. [Medline].

  4. Corman ML. Colon and Rectal Surgery. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1998:224-71.

  5. Dozois RR, Nichols JR. Surgery of the Colon and Rectum. New York, NY: Churchill Livingstone; 1997:255-84.

  6. Lunniss PJ, Phillips RKS. Anal Fistula: Surgical Evaluation and Management. London, England: Chapman & Hall; 1996:1-183.

  7. Nelson R. Anorectal abscess fistula: what do we know?. Surg Clin North Am. Dec 2002;82(6):1139-51, v-vi. [Medline].

  8. Gordon PH, Nivatvongs S, eds. Principles and Practice of Surgery for the Colon, Rectum and Anus. St Louis, Mo: Quality Medical Pub; 1999:241-86.

  9. Galandiuk S, Kimberling J, Al-Mishlab TG, et al. Perianal Crohn disease: predictors of need for permanent diversion. Ann Surg. May 2005;241(5):796-801; discussion 801-2. [Medline]. [Full Text].

  10. Guidi L, Ratto C, Semeraro S, et al. Combined therapy with infliximab and seton drainage for perianal fistulizing Crohn's disease with anal endosonographic monitoring: a single-centre experience. Tech Coloproctol. Jun 2008;12(2):111-7. [Medline].

  11. Malik AI, Nelson RL. Surgical management of anal fistulae: a systematic review. Colorectal Dis. Jun 2008;10(5):420-30. [Medline].

  12. Yeung JM, Alistair J, Simpson D, et al. Fibrin glue for the treatment of fistulae in ano - a method worth sticking to?. Colorectal Dis. Feb 7 2009;[Medline].

  13. Gupta PJ. Anal fistulotomy using radiowaves- long-term outcome. Acta Chir Iugosl. 2008;55(3):115-8. [Medline].

  14. Fish D, Kugathasan S. Inflammatory bowel disease. Adolesc Med Clin. Feb 2004;15(1):67-90, ix. [Medline].

  15. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. Jan 1976;63(1):1-12. [Medline].

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Further Reading

Related eMedicine topics:
 Crohn Disease [Gastroenterology]
Crohn Disease [Pediatrics: General Medicine]
Crohn Disease [Radiology]
Crohn Disease: Surgical Perspective
Fistula-in-Ano [General Surgery]
Fistula-in-Ano [Pediatrics: General Surgery]
Inflammatory Bowel Disease [Emergency Medicine]
Inflammatory Bowel Disease [Gastroenterology]
Inflammatory Bowel Disease [Ophthalmology]
Perianal and Perirectal Abscesses
Perianal Granuloma
Perirectal Abscess

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Keywords

perianal abscess, abscess, fistula, inflammatory bowel disease, abscesses, fistulas, abscess symptoms, fistula in ano, fistula-in-ano, perianal fistula, anal abscess, fistula abscess, anorectal abscess, ischiorectal abscess, perianal fistula, digital rectal examination, DRE, rectal pain

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Contributor Information and Disclosures

Author

Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Marc D Basson, MD, PhD, MBA is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Amy L Friedman, MD, Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse
Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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