UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Perianal and perirectal abscess

Authors
Elizabeth Breen, MD
Ronald Bleday, MD
Section Editors
Martin Weiser, MD
Lawrence S Friedman, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Perianal and perirectal abscesses are common anorectal problems. The infection originates most often from an obstructed anal crypt gland, with the resultant pus collecting in the subcutaneous tissue, intersphincteric plane, or beyond (ischiorectal space or supralevator space) where various types of anorectal abscesses form. Once diagnosed, anorectal abscesses should be promptly drained surgically. An undrained anorectal abscess can continue to expand into adjacent spaces as well as progress to generalized systemic infection.

Anorectal abscesses and fistulas can be thought of as two sequential phases of the same anorectal infectious process: an abscess represents the acute phase of infection, while a fistula represents the chronic phase of suppuration and fistulization [1]. Thus, it is not surprising that 30 to 70 percent of anorectal abscesses are associated with a concomitant anorectal fistula and that 30 to 40 percent of patients develop an anorectal fistula after undergoing treatment for an anorectal abscess [1,2].

The clinical manifestations, diagnosis, and management of anorectal abscess are discussed in this topic. Anorectal fistulas are reviewed in other topics. (See "Anorectal fistula: Clinical manifestations, diagnosis, and management principles" and "Operative management of anorectal fistulas".)

EPIDEMIOLOGY

It is estimated that there are approximately 100,000 cases of anorectal infection per year in the United States [1]. The incidence is likely an underestimate as many patients with anorectal symptoms prefer attributing them to "hemorrhoids" to seeking medical attention for an accurate diagnosis.

The mean age of presentation is 40 years (range 20 to 60) [3-6]. Adult males are twice as likely to develop an anorectal abscess and/or fistula compared with females [1,6].

                      
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: Jun 27, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg 2011; 24:14.
  2. Vogel JD, Johnson EK, Morris AM, et al. Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum 2016; 59:1117.
  3. Piazza DJ, Radhakrishnan J. Perianal abscess and fistula-in-ano in children. Dis Colon Rectum 1990; 33:1014.
  4. Niyogi A, Agarwal T, Broadhurst J, Abel RM. Management of perianal abscess and fistula-in-ano in children. Eur J Pediatr Surg 2010; 20:35.
  5. Nelson RL, Abcarian H, Davis FG, Persky V. Prevalence of benign anorectal disease in a randomly selected population. Dis Colon Rectum 1995; 38:341.
  6. Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 1984; 73:219.
  7. Rizzo JA, Naig AL, Johnson EK. Anorectal abscess and fistula-in-ano: evidence-based management. Surg Clin North Am 2010; 90:45.
  8. Barnett, JL, Raper, SE. Anorectal diseases. In: Yamada Textbook of Gastroenterology, 2nd edition, Yamada, T, Alpers, D, Owyang, et al (Eds), JB Lippincott, Philadelphia 1995. p.2027.
  9. Whiteford MH, Kilkenny J 3rd, Hyman N, et al. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum 2005; 48:1337.
  10. O'Malley GF, Dominici P, Giraldo P, et al. Routine packing of simple cutaneous abscesses is painful and probably unnecessary. Acad Emerg Med 2009; 16:470.
  11. Perera AP, Howell AM, Sodergren MH, et al. A pilot randomised controlled trial evaluating postoperative packing of the perianal abscess. Langenbecks Arch Surg 2015; 400:267.
  12. Tonkin DM, Murphy E, Brooke-Smith M, et al. Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity. Dis Colon Rectum 2004; 47:1510.
  13. Schouten WR, van Vroonhoven TJ. Treatment of anorectal abscess with or without primary fistulectomy. Results of a prospective randomized trial. Dis Colon Rectum 1991; 34:60.
  14. Tang CL, Chew SP, Seow-Choen F. Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscesses with proven internal opening. Dis Colon Rectum 1996; 39:1415.
  15. Ho YH, Tan M, Chui CH, et al. Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses. Dis Colon Rectum 1997; 40:1435.
  16. Oliver I, Lacueva FJ, Pérez Vicente F, et al. Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment. Int J Colorectal Dis 2003; 18:107.
  17. Malik AI, Nelson RL, Tou S. Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev 2010; :CD006827.
  18. Sözener U, Gedik E, Kessaf Aslar A, et al. Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study. Dis Colon Rectum 2011; 54:923.
  19. Frerich B, Ehrenfeld M, Cornelius CP, et al. [Treatment of keratocysts in deciduous and mixed dentitions]. Dtsch Zahnarztl Z 1991; 46:80.
  20. Brown SR, Horton JD, Davis KG. Perirectal abscess infections related to MRSA: a prevalent and underrecognized pathogen. J Surg Educ 2009; 66:264.