PERIANAL ABSCESS

Anorectal abscess
• results from infections of the
anal glands

• their ducts traverse the internal

sphincter and empty into the
anal crypts
• Infection of an anal
gland results in the
formation of an abscess
that enlarges and
spreads along
• perianal space
• intershinteric space
• ischiorectal space
• deep postanal space
• supralevator space
• Infection of an anal
gland results in the
formation of an abscess
that enlarges and
spreads along
• perianal space
• intershinteric space
• ischiorectal space
• deep postanal space
• supralevator space
A perianal abscess is the most common manifestation and
appears as a painful swelling at the anal verge.
 Diagnosis
• Severe anal pain
• Palpable mass detected by inspection or
by DRE
• Occasionally, will present with fever,
urinary retention, or life threatening
sepsis.
• Diagnosis can usually be made with
physical exam alone
• Complex or atypical presentations may
require CT or MRI to fully delineate the
anatomy of the abscess.
Treatment
• can be drained under local anesthesia in
office, clinic, or ER
• Larger, more complicated abscesses may
require drainage in the OR
• Skin incision is created, and a disk of skin
excised
• No packing
• Sitz baths started the next day
Treatment
• Antibiotics are indicated only
• extensive overlying cellulitis
• immunocompromised (diabetes mellitus or valvular heart disease)

• Antibiotics alone are ineffective at treating perianal/perirectal infection