Monday, March 8, 2021

Anorectal Abscesses

EmDocs - March 08, 2021 - By Kristina Eastman; Eva Ryder; Scarlet Benson
Reviewed by: Andrew Grock; Alex Koyfman; Brit Long
  • Suspect anorectal abscesses in patients with severe anorectal pain, especially when accompanied by fever or malaise.
  • Superficial anorectal abscesses can be diagnosed on physical examination by perianal erythema and a palpable, fluctuant, tender mass.
  • Perirectal abscesses can occasionally present with a tender, fluctuant mass on DRE, but may have limited physical exam findings and require imaging to diagnose.
  • For patients with evidence of deep infection, CT is the imaging modality of choice. Transperineal ultrasound has recently been recognized as a quick, easy, noninvasive, and cost-effective technique to diagnose and monitor for resolution of anorectal abscesses.
  • Perianal abscesses can be drained at the bedside in the ED while perirectal abscesses require surgical intervention in the operating room.
  • Immunocompromised patients can rapidly decompensate secondary to severe infection from anorectal abscesses. They require urgent surgical intervention.
  • After I&D of anorectal abscesses, immunocompromised patients require antibiotics.”