Perianal Abscess Workup

  • Author: Andre Hebra, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Jul 14, 2010
 

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.
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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. The ultrasound can also be used intraoperatively to help identify a difficult abscess/fistula.
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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. A fistula tract can be injected with peroxide solution at the time of examination under anesthesia in order to facilitate the visualization of the internal opening of the fistula.
  • 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.
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Contributor Information and Disclosures
Author

Andre Hebra, MD  Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

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, Children's Oncology Group, Florida Medical Association, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Marc D Basson, MD, PhD, MBA, FACS  Professor, Chair, Department of Surgery, Assistant Dean for Faculty Development in Research, Michigan State University College of Human Medicine

Marc D Basson, MD, PhD, MBA, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

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.

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 Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, 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 Consulting; ARdelyx Ownership interest Board membership

References

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  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].

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  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].

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  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].

  16. [Best Evidence] Hyman N, O'Brien S, Osler T. Outcomes after fistulotomy: results of a prospective, multicenter regional study. Dis Colon Rectum. 2009;52:2022-7. [Medline].

 
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Illustration of the major types of anorectal abscesses (submucosal not pictured).
Diagram illustrating the Goodsall rule for anorectal fistulas. Fistulas that exit in the posterior half of the rectum generally follow a curved course toward the posterior midline, while those that exit in the anterior half of the rectum usually follow a radial course to the dentate line.
Illustration of the Goodsall rule for anorectal fistulas. Note the curved nature of the posterior fistulas and the radial (straight) orientation of the anterior fistulas.
 
 
 
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