Perirectal Abscess Follow-up
- Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM more...
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 gangrene[7]
- Epidural abscess (a rare complication of fistulizing Crohn disease)
- Death
Prognosis
- With adequate treatment, the prognosis is generally excellent.
Patient Education
- For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education articles Anal Abscess, Rectal Pain, and Rectal Bleeding.
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