eMedicine Specialties > Emergency Medicine > Gastrointestinal

Perirectal Abscess: Follow-up

Author: Drew Evan Fenton, MD, Hospitalist, Our Health Care Consultants
Contributor Information and Disclosures

Updated: Nov 20, 2009

Follow-up

Further Inpatient Care

  • The patient with perirectal abscess should be admitted to the surgical service unless other medical conditions or complications from the abscess necessitate a primary medical admission, with the surgeon acting as a consultant. Consider admitting a patient with a perirectal abscess to a medical service with the surgeon as a consultant if the patient is elderly, febrile, hypotensive, or immune compromised or has significant comorbidities.
  • Generally, the treatment of a perirectal abscess is incision and debridement in an operating suite performed by an experienced surgeon.

Further Outpatient Care

  • Advise patients to return immediately to the ED or to another provider for any unusual symptoms, including persistent pain or fever.
  • After inpatient surgical treatment, a surgeon should closely monitor patients because of the frequent occurrence of fistula or recurrence of the abscess.
  • An otherwise healthy patient with a simple isolated perianal abscess may be treated in the ED with incision and drainage and released with timely follow-up care. Keep in mind that a simple perianal abscess is very, very rare. The overwhelming likelihood, when one considers the diagnosis of perianal abscess, is that the provider is only observing the point of a perirectal abscess.

Inpatient & Outpatient Medications

  • Provide adequate outpatient analgesia such as codeine with acetaminophen or an oxycodone-containing compound.
  • Outpatient antibiotics may be indicated and are best chosen according to the culture and sensitivity of pathogens derived from the abscess.

Transfer

  • Hemodynamically stable patients may be transferred safely.
  • Instability from a concurrent condition or sepsis makes transfer to another institution inappropriate (and possibly illegal under the Emergency Medical Treatment and Active Labor Act [EMTALA]) unless a higher level of care transfer is in the patient's best interest.

Complications

  • Fistula formation
  • Bacteremia and sepsis, including seeding of the infection to other areas by hematogenous spread (See Emergency Department Care.)
  • Fournier gangrene7
  • Epidural abscess (a rare complication of fistulizing Crohn disease)
  • Death

Prognosis

  • With adequate treatment, the prognosis is generally excellent.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Delayed diagnosis, misdiagnosis, or failure to diagnose, resulting in a complication or death
  • Inadequate treatment or failure to refer for adequate surgical debridement, resulting in a complication or death
  • Aspiration, hypoxic injury, or death as a result of inadequate airway management with the use of conscious sedation
  • Overzealous packing of a perirectal abscess cavity (See Emergency Department Care.)
 


More on Perirectal Abscess

Overview: Perirectal Abscess
Differential Diagnoses & Workup: Perirectal Abscess
Treatment & Medication: Perirectal Abscess
Follow-up: Perirectal Abscess
References
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References

  1. Brook I, Frazier EH. The aerobic and anaerobic bacteriology of perirectal abscesses. J Clin Microbiol. Nov 1997;35(11):2974-6. [Medline].

  2. Festen C, van Harten H. Perianal abscess and fistula-in-ano in infants. J Pediatr Surg. May 1998;33(5):711-3. [Medline].

  3. Zaheer S, Reilly WT, Pemberton JH, Ilstrup D. Urinary retention after operations for benign anorectal diseases. Dis Colon Rectum. Jun 1998;41(6):696-704. [Medline].

  4. Marcus RH, Stine RJ, Cohen MA. Perirectal abscess. Ann Emerg Med. May 1995;25(5):597-603. [Medline].

  5. Stewart LK, McGee J, Wilson SR. Transperineal and transvaginal sonography of perianal inflammatory disease. AJR Am J Roentgenol. Sep 2001;177(3):627-32. [Medline].

  6. Cuenod CA, de Parades V, Siauve N, Marteau P, Grataloup C, Hernigou A, et al. [MR imaging of ano-perineal suppurations]. J Radiol. Apr 2003;84(4 Pt 2):516-28. [Medline].

  7. Montoya Chinchilla R, Izquierdo Morejon E, et al. Fournier's gangrene. Descriptive analysis of 20 cases and literature review. Actas Urol Esp. Sep 2009;33(8):873-880. [Medline].

  8. Andersson P, Olaison G, Hallbook O, Boeryd B, Sjodahl R. Increased anal resting pressure and rectal sensitivity in Crohn's disease. Dis Colon Rectum. Dec 2003;46(12):1685-9. [Medline].

  9. Cataldo PA, Senagore A, Luchtefeld MA. Intrarectal ultrasound in the evaluation of perirectal abscesses. Dis Colon Rectum. Jun 1993;36(6):554-8. [Medline].

  10. 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].

  11. Giovannini M, Bories E, Moutardier V, Pesenti C, Guillemin A, Lelong B, et al. Drainage of deep pelvic abscesses using therapeutic echo endoscopy. Endoscopy. Jun 2003;35(6):511-4. [Medline].

  12. Heidemann J, Spinelli KS, Otterson MF, Binion DG. Case report: magnetic resonance imaging in the diagnosis of epidural abscess complicating perirectal fistulizing Crohn's disease. Inflamm Bowel Dis. Mar 2003;9(2):122-4. [Medline].

  13. Kattan S, Youssef A. Fournier's gangrene of the scrotum following anorectal disorders. Int Urol Nephrol. 1994;26(2):215-22. [Medline].

  14. Laniado M, Makowiec F, Dammann F, Jehle EC, Claussen CD, Starlinger M. Perianal complications of Crohn disease: MR imaging findings. Eur Radiol. 1997;7(7):1035-42. [Medline].

  15. Lobo Martínez E, Torres Aleman A, Galindo Alvarez J, Martinez Molina E. Endoanal ultrasound in perirectal abscesses. Rev Esp Enferm Dig. Dec 1997;89(12):897-902. [Medline].

  16. Nomikos IN. Anorectal abscesses: need for accurate anatomical localization of the disease. Clin Anat. 1997;10(4):239-44. [Medline].

  17. Rubens DJ, Strang JG, Bogineni-Misra S, Wexler IE. Transperineal sonography of the rectum: anatomy and pathology revealed by sonography compared with CT and MR imaging. AJR Am J Roentgenol. Mar 1998;170(3):637-42. [Medline].

  18. Stoker J, Rociu E, Wiersma TG, Lameris JS. Imaging of anorectal disease. Br J Surg. Jan 2000;87(1):10-27. [Medline].

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Further Reading

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Keywords

perirectal abscess, perianal abscess, perirectal abscess treatment, perirectal abscess symptoms, perirectal abscess diagnosis, infection of the mucus-secreting anal glands, anorectal abscess

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Contributor Information and Disclosures

Author

Drew Evan Fenton, MD, Hospitalist, Our Health Care Consultants
Drew Evan Fenton, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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