eMedicine Specialties > General Surgery > Colorectal

Perianal Abscess: Follow-up

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

Outcome and Prognosis

Approximately two thirds of patients with rectal abscesses who are treated by incision and drainage or by spontaneous drainage will develop a chronic anal fistula.

The recurrence rate of anorectal fistulas after fistulotomy, fistulectomy, or the use of a seton is about 1.5%.

The overall incidence of major fecal incontinence after the surgical management of complex suprasphincteric fistulas is estimated to be approximately 7%.

Future and Controversies

Some surgeons advise performing a complementary colostomy to facilitate the management of complex anal fistulas. This may be of some benefit in selected cases, but the perirectal infection may continue despite a diverting colostomy. Adequate drainage of the abscess is the most important factor in controlling progressive perirectal infection.

 
Acknowledgments

The editors would like to thank Patrick B Thomas, MD, Fellow, Department of Pediatric Surgery, Texas Children's Hospital, for his participation in this article.



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

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  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].

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  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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