Anal Fistulas and Fissures Workup

  • Author: Ingrid Legall, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Mar 29, 2012
 

Approach Considerations

Diagnosis of an anal fissure is primarily based on the history and physical examination. Evaluation of an anal fistula involves at least a complete blood count (CBC) and a blood culture. Look at the number of white blood cells (WBCs) in anyone with a significant infection. Depending on the condition of the patient, the possibility of bacteremia or sepsis must be considered. Blood cultures better identify the offending organism, making it possible to treat infection more effectively.

If syphilis or chlamydial infection is in the differential diagnosis, wound cultures may be necessary.

Because of the increased prevalence of methicillin-resistant Staphylococcus aureus (MRSA) bacteria encountered in the general community, wound cultures for this organism should be performed. If MRSA is present, antibiotic therapy needs to be tailored to this specific organism; otherwise, prolonged infection and complications such as bacteremia are more likely to occur.

If the extent of the underlying abscess is not known, a CT scan may be necessary to delineate its boundaries.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Ingrid Legall, MD  Assistant Professor, Department of Emergency Medicine, Florida Hospital-Flagler

Ingrid Legall, MD is a member of the following medical societies: American Academy of Emergency Medicine and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

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.

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.

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

References

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Anal fistulas and fissures. This patient reported constipation.
Anal fistulas and fissures. This patient has a history of Crohn disease.
 
 
 
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