Anorectal abscess - Revision history

Ostermayer: Marked this version for translation

2026-01-06T20:30:23Z

Marked this version for translation

← Older revision		Revision as of 20:30, 6 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	[[File:Abscess diag 02.png\|thumb\|Anorectal abscess types and their locations.]]		[[File:Abscess diag 02.png\|thumb\|Anorectal abscess types and their locations.]]
	*Usually begin via blocked anal gland (leads to infection/[[Special:MyLanguage/abscess\|abscess]] formation)		*Usually begin via blocked anal gland (leads to infection/[[Special:MyLanguage/abscess\|abscess]] formation)
	**Can progress to involve any of the potential spaces.		**Can progress to involve any of the potential spaces.

			<!--T:3-->
	{\| {{table}}		{\| {{table}}
	\| align="center" style="background:#f0f0f0;"\|''' '''		\| align="center" style="background:#f0f0f0;"\|''' '''
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	===Risk Factors===		===Risk Factors=== <!--T:4-->

			<!--T:5-->
	*[[Special:MyLanguage/Crohn's disease\|Crohn's disease]]		*[[Special:MyLanguage/Crohn's disease\|Crohn's disease]]
	*Chronic [[Special:MyLanguage/constipation\|constipation]]		*Chronic [[Special:MyLanguage/constipation\|constipation]]
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	==Clinical Features==		==Clinical Features== <!--T:6-->

			<!--T:7-->
	[[File:Perianalabscess.jpg\|thumb\|Perianal abscess.]]		[[File:Perianalabscess.jpg\|thumb\|Perianal abscess.]]
	[[File:Perianalabszess 01.jpg\|thumb\|Perianal abscess.]]		[[File:Perianalabszess 01.jpg\|thumb\|Perianal abscess.]]
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:8-->

	</translate>		</translate>
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	==Evaluation==		==Evaluation== <!--T:9-->

			<!--T:10-->
	*CT with IV contrast can be useful to define deep abscesses (especially with pain out of proportion to exam)		*CT with IV contrast can be useful to define deep abscesses (especially with pain out of proportion to exam)
	*May consider [[Special:MyLanguage/ultrasound\|ultrasound]] or MRI as alternatives		*May consider [[Special:MyLanguage/ultrasound\|ultrasound]] or MRI as alternatives


	==Management==		==Management== <!--T:11-->

			<!--T:12-->
	*Isolated perianal [[Special:MyLanguage/abscess\|abscess]] is only type of anorectal [[Special:MyLanguage/abscess\|abscess]] that should be treated in ED		*Isolated perianal [[Special:MyLanguage/abscess\|abscess]] is only type of anorectal [[Special:MyLanguage/abscess\|abscess]] that should be treated in ED
	**Consider either linear incision with packing, elliptical incision, or cruciate incision without packing		**Consider either linear incision with packing, elliptical incision, or cruciate incision without packing
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	===Antibiotics===		===Antibiotics=== <!--T:13-->

			<!--T:14-->
	''Causative organisms: Mixed infection with fecal flora for [[Special:MyLanguage/anaerobes\|anaerobes]] and [[Special:MyLanguage/Gram Negatives\|Gram Negatives]] ([[Special:MyLanguage/Bacteroides fragilis\|Bacteroides fragilis]] and [[Special:MyLanguage/Escherichia coli\|Escherichia coli]])''		''Causative organisms: Mixed infection with fecal flora for [[Special:MyLanguage/anaerobes\|anaerobes]] and [[Special:MyLanguage/Gram Negatives\|Gram Negatives]] ([[Special:MyLanguage/Bacteroides fragilis\|Bacteroides fragilis]] and [[Special:MyLanguage/Escherichia coli\|Escherichia coli]])''

			<!--T:15-->
	'''Use is controversial'''		'''Use is controversial'''
	*Only recommended in high risk patients:<ref>BMJ Best Practice Anorectal [[Special:MyLanguage/abscess\|abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[Special:MyLanguage/abscess\|abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref>		*Only recommended in high risk patients:<ref>BMJ Best Practice Anorectal [[Special:MyLanguage/abscess\|abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[Special:MyLanguage/abscess\|abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref>
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	*Possibly prevent [[Special:MyLanguage/anal fistula\|fistula]] formation in otherwise healthy patients<ref>Mocanu V, Dang JT, Ladak F, et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis. Am J Surg. 2019;217(5):910-917.</ref>		*Possibly prevent [[Special:MyLanguage/anal fistula\|fistula]] formation in otherwise healthy patients<ref>Mocanu V, Dang JT, Ladak F, et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis. Am J Surg. 2019;217(5):910-917.</ref>

			<!--T:16-->
	'''Treatment options:'''		'''Treatment options:'''
	*[[Special:MyLanguage/Augmentin\|Augmentin]]		*[[Special:MyLanguage/Augmentin\|Augmentin]]
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	==Disposition==		==Disposition== <!--T:17-->


	===Discharge===		===Discharge=== <!--T:18-->

			<!--T:19-->
	*Perianal abscess		*Perianal abscess


	==See Also==		==See Also== <!--T:20-->

			<!--T:21-->
	*[[Special:MyLanguage/Anorectal Disorders\|Anorectal Disorders]]		*[[Special:MyLanguage/Anorectal Disorders\|Anorectal Disorders]]


	==External Links==		==External Links== <!--T:22-->

			<!--T:23-->
	*[http://vimeo.com/59270692 Rob Orman Lecture]		*[http://vimeo.com/59270692 Rob Orman Lecture]


	==References==		==References== <!--T:24-->

			<!--T:25-->
	<references/>		<references/>

			<!--T:26-->
	[[Category:GI]]		[[Category:GI]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:39:39Z

Prepared the page for translation

← Older revision		Revision as of 21:39, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Abscess diag 02.png\|thumb\|Anorectal abscess types and their locations.]]		[[File:Abscess diag 02.png\|thumb\|Anorectal abscess types and their locations.]]
	*Usually begin via blocked anal gland (leads to infection/[[abscess]] formation)		*Usually begin via blocked anal gland (leads to infection/[[Special:MyLanguage/abscess\|abscess]] formation)
	**Can progress to involve any of the potential spaces.		**Can progress to involve any of the potential spaces.

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	\| '''Symptoms'''\|\|Located close to anal verge, posterior midline, superficial tender mass\|\|Larger, indurated, well-circumscribed, located laterally on medial aspect of buttocks\|\|Rectal pain, skin signs may not be present		\| '''Symptoms'''\|\|Located close to anal verge, posterior midline, superficial tender mass\|\|Larger, indurated, well-circumscribed, located laterally on medial aspect of buttocks\|\|Rectal pain, skin signs may not be present
	\|-		\|-
	\| '''Comments'''\|\|High incidence of [[anal fistula\|fistula]] formation even with drainage\|\|\|\|Constitutional symptoms often present		\| '''Comments'''\|\|High incidence of [[Special:MyLanguage/anal fistula\|fistula]] formation even with drainage\|\|\|\|Constitutional symptoms often present
	\|}		\|}


	===Risk Factors===		===Risk Factors===
	*[[Crohn's disease]]
	*Chronic [[constipation]]		*[[Special:MyLanguage/Crohn's disease\|Crohn's disease]]
	*[[Diabetes mellitus]]		*Chronic [[Special:MyLanguage/constipation\|constipation]]
	*Chronic [[corticosteroid]] use		*[[Special:MyLanguage/Diabetes mellitus\|Diabetes mellitus]]
			*Chronic [[Special:MyLanguage/corticosteroid\|corticosteroid]] use


	==Clinical Features==		==Clinical Features==

	[[File:Perianalabscess.jpg\|thumb\|Perianal abscess.]]		[[File:Perianalabscess.jpg\|thumb\|Perianal abscess.]]
	[[File:Perianalabszess 01.jpg\|thumb\|Perianal abscess.]]		[[File:Perianalabszess 01.jpg\|thumb\|Perianal abscess.]]
	*Worsening pain around bowel movement, with decreased pain post rectal evacuation		*Worsening pain around bowel movement, with decreased pain post rectal evacuation
	*Perirectal abscesses often accompanied by [[fever]], [[leukocytosis]]		*Perirectal abscesses often accompanied by [[Special:MyLanguage/fever\|fever]], [[Special:MyLanguage/leukocytosis\|leukocytosis]]
	**May only be palpable via digital rectal exam		**May only be palpable via digital rectal exam
	**Perianal abscesses typically do not cause fever in immunocompetent individuals		**Perianal abscesses typically do not cause fever in immunocompetent individuals
	*Tender inguinal [[lymphadenopathy]] may be only clue to deeper abscesses		*Tender inguinal [[Special:MyLanguage/lymphadenopathy\|lymphadenopathy]] may be only clue to deeper abscesses


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Anorectal DDX}}		{{Anorectal DDX}}
			<translate>
			</translate>
	{{SSTI DDX}}		{{SSTI DDX}}
			<translate>


	==Evaluation==		==Evaluation==

	*CT with IV contrast can be useful to define deep abscesses (especially with pain out of proportion to exam)		*CT with IV contrast can be useful to define deep abscesses (especially with pain out of proportion to exam)
	*May consider [[ultrasound]] or MRI as alternatives		*May consider [[Special:MyLanguage/ultrasound\|ultrasound]] or MRI as alternatives


	==Management==		==Management==
	*Isolated perianal [[abscess]] is only type of anorectal [[abscess]] that should be treated in ED
			*Isolated perianal [[Special:MyLanguage/abscess\|abscess]] is only type of anorectal [[Special:MyLanguage/abscess\|abscess]] that should be treated in ED
	**Consider either linear incision with packing, elliptical incision, or cruciate incision without packing		**Consider either linear incision with packing, elliptical incision, or cruciate incision without packing
	**Frequent sitz baths		**Frequent sitz baths
	*All perirectal abscesses (ischiorectal, intersphincteric, supralevator) should be drained in the OR		*All perirectal abscesses (ischiorectal, intersphincteric, supralevator) should be drained in the OR
	*All anorectal abscesses require surgical referral and follow up		*All anorectal abscesses require surgical referral and follow up


	===Antibiotics===		===Antibiotics===
	''Causative organisms: Mixed infection with fecal flora for [[anaerobes]] and [[Gram Negatives]] ([[Bacteroides fragilis]] and [[Escherichia coli]])''
			''Causative organisms: Mixed infection with fecal flora for [[Special:MyLanguage/anaerobes\|anaerobes]] and [[Special:MyLanguage/Gram Negatives\|Gram Negatives]] ([[Special:MyLanguage/Bacteroides fragilis\|Bacteroides fragilis]] and [[Special:MyLanguage/Escherichia coli\|Escherichia coli]])''

	'''Use is controversial'''		'''Use is controversial'''
	*Only recommended in high risk patients:<ref>BMJ Best Practice Anorectal [[abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref>		*Only recommended in high risk patients:<ref>BMJ Best Practice Anorectal [[Special:MyLanguage/abscess\|abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[Special:MyLanguage/abscess\|abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref>
	**Elderly		**Elderly
	**Diabetics		**Diabetics
	**Systemic signs ([[fever]], [[leukocytosis]])		**Systemic signs ([[Special:MyLanguage/fever\|fever]], [[Special:MyLanguage/leukocytosis\|leukocytosis]])
	**[[Valvular heart disease]]		**[[Special:MyLanguage/Valvular heart disease\|Valvular heart disease]]
	**[[Cellulitis]]		**[[Special:MyLanguage/Cellulitis\|Cellulitis]]
	**Immunosuppression		**Immunosuppression
	*Possibly prevent [[anal fistula\|fistula]] formation in otherwise healthy patients<ref>Mocanu V, Dang JT, Ladak F, et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis. Am J Surg. 2019;217(5):910-917.</ref>		*Possibly prevent [[Special:MyLanguage/anal fistula\|fistula]] formation in otherwise healthy patients<ref>Mocanu V, Dang JT, Ladak F, et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis. Am J Surg. 2019;217(5):910-917.</ref>

	'''Treatment options:'''		'''Treatment options:'''
	*[[Augmentin]]		*[[Special:MyLanguage/Augmentin\|Augmentin]]
	*[[Ciprofloxacin]] 500mg PO BID '''and''' [[Metronidazole]] 500mg PO TID		*[[Special:MyLanguage/Ciprofloxacin\|Ciprofloxacin]] 500mg PO BID '''and''' [[Special:MyLanguage/Metronidazole\|Metronidazole]] 500mg PO TID


	==Disposition==		==Disposition==


	===Discharge===		===Discharge===

	*Perianal abscess		*Perianal abscess


	==See Also==		==See Also==
	*[[Anorectal Disorders]]
			*[[Special:MyLanguage/Anorectal Disorders\|Anorectal Disorders]]


	==External Links==		==External Links==

	*[http://vimeo.com/59270692 Rob Orman Lecture]		*[http://vimeo.com/59270692 Rob Orman Lecture]


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
			</translate>

Rossdonaldson1: /* Disposition */

2024-03-06T19:46:07Z

Disposition

← Older revision		Revision as of 19:46, 6 March 2024
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	==Disposition==		==Disposition==
	Discharge		===Discharge===
	*Perianal abscess		*Perianal abscess

Rossdonaldson1: /* External Links */

2024-03-06T19:45:50Z

External Links

← Older revision		Revision as of 19:45, 6 March 2024
Line 72:		Line 72:

	==External Links==		==External Links==
	[http://vimeo.com/59270692 Rob Orman Lecture]		*[http://vimeo.com/59270692 Rob Orman Lecture]

	==References==		==References==

Mmcconaughy: /* Antibiotics */

2021-07-28T20:18:57Z

Antibiotics

← Older revision		Revision as of 20:18, 28 July 2021
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	*Only recommended in high risk patients:<ref>BMJ Best Practice Anorectal [[abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref>		*Only recommended in high risk patients:<ref>BMJ Best Practice Anorectal [[abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref>
	**Elderly		**Elderly
			**Diabetics
	**Systemic signs ([[fever]], [[leukocytosis]])		**Systemic signs ([[fever]], [[leukocytosis]])
	**[[Valvular heart disease]]		**[[Valvular heart disease]]

Rossdonaldson1: /* Clinical Features */

2021-07-07T19:19:01Z

Clinical Features

← Older revision		Revision as of 19:19, 7 July 2021
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	==Clinical Features==		==Clinical Features==
	[[File:Perianalabscess.jpg\|thumb\|Perianal abscess.]]		[[File:Perianalabscess.jpg\|thumb\|Perianal abscess.]]
			[[File:Perianalabszess 01.jpg\|thumb\|Perianal abscess.]]
	*Worsening pain around bowel movement, with decreased pain post rectal evacuation		*Worsening pain around bowel movement, with decreased pain post rectal evacuation
	*Perirectal abscesses often accompanied by [[fever]], [[leukocytosis]]		*Perirectal abscesses often accompanied by [[fever]], [[leukocytosis]]

Rossdonaldson1: /* Clinical Features */

2021-07-07T19:17:28Z

Clinical Features

← Older revision		Revision as of 19:17, 7 July 2021
Line 24:		Line 24:

	==Clinical Features==		==Clinical Features==
			[[File:Perianalabscess.jpg\|thumb\|Perianal abscess.]]
	*Worsening pain around bowel movement, with decreased pain post rectal evacuation		*Worsening pain around bowel movement, with decreased pain post rectal evacuation
	*Perirectal abscesses often accompanied by [[fever]], [[leukocytosis]]		*Perirectal abscesses often accompanied by [[fever]], [[leukocytosis]]

Rossdonaldson1: /* Background */

2021-07-07T19:16:30Z

Background

← Older revision		Revision as of 19:16, 7 July 2021
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Abscess diag 02.png\|thumb\|Anorectal abscess types and their locations.]]
	*Usually begin via blocked anal gland (leads to infection/[[abscess]] formation)		*Usually begin via blocked anal gland (leads to infection/[[abscess]] formation)
	**Can progress to involve any of the potential spaces.		**Can progress to involve any of the potential spaces.

Elcatracho: /* Clinical Features */

2021-01-30T20:49:25Z

Clinical Features

← Older revision		Revision as of 20:49, 30 January 2021
Line 26:		Line 26:
	*Perirectal abscesses often accompanied by [[fever]], [[leukocytosis]]		*Perirectal abscesses often accompanied by [[fever]], [[leukocytosis]]
	**May only be palpable via digital rectal exam		**May only be palpable via digital rectal exam
			**Perianal abscesses typically do not cause fever in immunocompetent individuals
	*Tender inguinal [[lymphadenopathy]] may be only clue to deeper abscesses		*Tender inguinal [[lymphadenopathy]] may be only clue to deeper abscesses

ClaireLewis at 19:06, 29 September 2019

2019-09-29T19:06:04Z

← Older revision		Revision as of 19:06, 29 September 2019
Line 13:		Line 13:
	\| '''Symptoms'''\|\|Located close to anal verge, posterior midline, superficial tender mass\|\|Larger, indurated, well-circumscribed, located laterally on medial aspect of buttocks\|\|Rectal pain, skin signs may not be present		\| '''Symptoms'''\|\|Located close to anal verge, posterior midline, superficial tender mass\|\|Larger, indurated, well-circumscribed, located laterally on medial aspect of buttocks\|\|Rectal pain, skin signs may not be present
	\|-		\|-
	\| '''Comments'''\|\|High incidence of fistula formation even with drainage\|\|\|\|Constitutional symptoms often present		\| '''Comments'''\|\|High incidence of [[anal fistula\|fistula]] formation even with drainage\|\|\|\|Constitutional symptoms often present
	\|}		\|}

	===Risk Factors===		===Risk Factors===
	*[[~~Crohn’s~~ disease]]		*[[Crohn's disease]]
	*Chronic [[constipation]]		*Chronic [[constipation]]
	*[[Diabetes mellitus]]		*[[Diabetes mellitus]]
Line 24:		Line 24:
	==Clinical Features==		==Clinical Features==
	*Worsening pain around bowel movement, with decreased pain post rectal evacuation		*Worsening pain around bowel movement, with decreased pain post rectal evacuation
	*Perirectal abscesses often accompanied by fever, leukocytosis		*Perirectal abscesses often accompanied by [[fever]], [[leukocytosis]]
	**May only be ~~paplpable~~ via digital rectal exam		**May only be palpable via digital rectal exam
	*Tender inguinal ~~adenopathy~~ may be only clue to deeper abscesses		*Tender inguinal [[lymphadenopathy]] may be only clue to deeper abscesses

	==Differential Diagnosis==		==Differential Diagnosis==
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	**Frequent sitz baths		**Frequent sitz baths
	*All perirectal abscesses (ischiorectal, intersphincteric, supralevator) should be drained in the OR		*All perirectal abscesses (ischiorectal, intersphincteric, supralevator) should be drained in the OR
	*All anorectal abscesses require surgical referral and ~~followup~~		*All anorectal abscesses require surgical referral and follow up

	===Antibiotics===		===Antibiotics===
Line 49:		Line 49:
	*Only recommended in high risk patients:<ref>BMJ Best Practice Anorectal [[abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref>		*Only recommended in high risk patients:<ref>BMJ Best Practice Anorectal [[abscess]] http://bestpractice.bmj.com/best-practice/monograph/644/treatment/step-by-step.html</ref><ref>Guidelines.gov - Practice parameters for the management of perianal [[abscess]] and fistula-in-ano.http://www.guideline.gov/content.aspx?id=36077</ref>
	**Elderly		**Elderly
	**Systemic signs (fever, leukocytosis)		**Systemic signs ([[fever]], [[leukocytosis]])
	**Valvular heart disease		**[[Valvular heart disease]]
	**Cellulitis		**[[Cellulitis]]
	**Immunosuppression		**Immunosuppression
	*Possibly prevent fistula formation in otherwise healthy patients<ref>Mocanu V, Dang JT, Ladak F, et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis. Am J Surg. 2019;217(5):910-917.</ref>		*Possibly prevent [[anal fistula\|fistula]] formation in otherwise healthy patients<ref>Mocanu V, Dang JT, Ladak F, et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis. Am J Surg. 2019;217(5):910-917.</ref>

	'''Treatment options:'''		'''Treatment options:'''
	*Augmentin		*[[Augmentin]]
	*[[Ciprofloxacin]] 500mg PO BID '''and''' [[Metronidazole]] 500mg PO TID		*[[Ciprofloxacin]] 500mg PO BID '''and''' [[Metronidazole]] 500mg PO TID