Perirectal Abscess Follow-up

  • Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Jul 16, 2010
 

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.
Next

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.
Previous
Next

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.
Previous
Next

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.
Previous
Next

Complications

  • Fistula formation
  • Bacteremia and sepsis, including seeding of the infection to other areas by hematogenous spread (See Emergency Department Care.)
  • Fournier gangrene[7]
  • Epidural abscess (a rare complication of fistulizing Crohn disease)
  • Death
Previous
Next

Prognosis

  • With adequate treatment, the prognosis is generally excellent.
Previous
Next

Patient Education

Previous
 
Contributor Information and Disclosures
Author

Michael S Beeson, MD, MBA, FACEP  Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

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.

Specialty Editor Board

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

Disclosure: Medscape Salary Employment

Eugene Hardin, 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.

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  Chair, Department of Emergency Medicine, LeConte 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.

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].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.