Highlights & Basics
- Anorectal abscess commonly presents with perianal pain with leukocytosis.
- Usually treated by incision and drainage.
- Adjunctive antibiotics are unnecessary for uncomplicated cases. Antibiotics are indicated for patients with associated cellulitis, immunocompromise, signs of systemic infection, diabetes, or a history of cardiac valvular disease.
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Definition
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Citations
Gaertner WB, Burgess PL, Davids JS, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum. 2022 Aug 1;65(8):964-85.[Abstract][Full Text]
Nomikos IN. Anorectal abscesses: need for accurate anatomical localization of the disease. Clin Anat. 1997;10:239-44.[Abstract]
Wright WF. Infectious diseases perspective of anorectal abscess and fistula-in-ano disease. Am J Med Sci. 2016 Apr;351(4):427-34.[Abstract]
Malik AI, Nelson RL, Tou S. Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD006827.[Abstract][Full Text]
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4. Gaertner WB, Burgess PL, Davids JS, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum. 2022 Aug 1;65(8):964-85.[Abstract][Full Text]
5. Expert Panel on Gastrointestinal Imaging., Levy AD, Liu PS, et al. ACR Appropriateness Criteria® anorectal disease. J Am Coll Radiol. 2021 Nov;18(11s):S268-S282.[Abstract][Full Text]
6. Steele SR, Kumar R, Feingold DL, et al. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011 Dec;54(12):1465-74.[Abstract]
7. Nomikos IN. Anorectal abscesses: need for accurate anatomical localization of the disease. Clin Anat. 1997;10:239-44.[Abstract]
8. Godec CJ, Cass AS, Ruiz E. Another aspect of acute urinary retention in young patients. Ann Emerg Med. 1982 Sep;11(9):471-4.[Abstract]
9. Ramanujam PS, Prasad ML, Abcarian H, et al. Perianal abscesses and fistulas. A study of 1023 patients. Dis Colon Rectum. 1984 Sep;27(9):593-7.[Abstract]
10. Prasad ML, Read DR, Abcarian H. Supralevator abscess: diagnosis and treatment. Dis Colon Rectum. 1981 Sep;24(6):456-61.[Abstract]
11. Salvino C, Harford FJ, Dobrin PB. Necrotizing infections of the perineum. South Med J. 1993 Aug;86(8):908-11.[Abstract]
12. Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg. 2011 Mar;24(1):14-21.[Abstract]
13. Sahnan K, Askari A, Adegbola SO, et al. Natural history of anorectal sepsis. Br J Surg. 2017 Dec;104(13):1857-65.[Abstract][Full Text]
14. Wright WF. Infectious diseases perspective of anorectal abscess and fistula-in-ano disease. Am J Med Sci. 2016 Apr;351(4):427-34.[Abstract]
15. Kovalcik PJ, Peniston RL, Cross GH. Anorectal abscess. Surg Gynecol Obstet. 1979 Dec;149(6):884-6.[Abstract]
16. Millan M, Garcia-Granero E, Esclapez P, et al. Management of intersphincteric abscesses. Colorectal Dis. 2006 Nov;8(9):777-80.[Abstract]
17. Onaca N, Hirshberg A, Adar R. Early reoperation for perirectal abscess: a preventable complication. Dis Colon Rectum. 2001 Oct;44(10):1469-73.[Abstract]
18. Grace RH, Harper IA, Thompson RG. Anorectal sepsis: microbiology in relation to fistula-in-ano. Br J Surg. 1982 Jul;69(7):401-3.[Abstract]
19. Lunniss PJ, Phillips RK. Surgical assessment of acute anorectal sepsis is a better predictor of fistula than microbiological analysis. Br J Surg. 1994 Mar;81(3):368-9.[Abstract]
20. Magdeburg R, Grobholz R, Dornschneider G, et al. Perianal abscess caused by Actinomyces: report of a case. Tech Coloproctol. 2008 Dec;12(4):347-9.[Abstract]
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22. Rafal RB, Nichols JN, Cennerazzo WJ, et al. MRI for evaluation of perianal inflammation. Abdom Imaging. 1995 May-Jun;20(3):248-52.[Abstract]
23. Williams JG, MacLeod CA, Rothenberger DA, et al. Seton treatment of high anal fistulae. Br J Surg. 1991 Oct;78(10):1159-61.[Abstract]
24. Sarani B, Strong M, Pascual J, et al. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009 Feb;208(2):279-88.[Abstract]
25. Sullivan PS, Moreno C. A Multidisciplinary approach to perianal and intra-abdominal infections in the neutropenic cancer patient. Oncology (Williston Park). 2015 Aug;29(8):581-90.[Abstract][Full Text]
26. Sangwan YP, Schoetz DJ Jr, Murray JJ, et al. Perianal Crohn's disease. Results of local surgical treatment. Dis Colon Rectum. 1996 May;39(5):529-35.[Abstract]
27. Vasilevsky CA, Gordon PH. The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum. 1984 Feb;27(2):126-30.[Abstract]
28. 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 Dec;39(12):1415-7.[Abstract]
29. Schouten WR, van Vroonhoven TJ. Treatment of anorectal abscess with or without primary fistulectomy. Results of a prospective randomized trial. Dis Colon Rectum. 1991 Jan;34(1):60-3.[Abstract]
30. Cox SW, Senagore AJ, Luchtefeld MA, et al. Outcome after incision and drainage with fistulotomy for ischiorectal abscess. Am Surg. 1997 Aug;63(8):686-9.[Abstract]
31. Knoefel WT, Hosch SB, Hoyer B, et al. The initial approach to anorectal abscesses: fistulotomy is safe and reduces the chance of recurrences. Dig Surg. 2000;17(3):274-8.[Abstract]
32. Malik AI, Nelson RL, Tou S. Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD006827.[Abstract][Full Text]
33. Smith SR, Newton K, Smith JA, et al. Internal dressings for healing perianal abscess cavities. Cochrane Database Syst Rev. 2016 Aug 26;(8):CD011193.[Abstract][Full Text]
34. Garcia-Aguilar J, Belmonte C, Wong WD, et al. Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum. 1996 Jul;39(7):723-9.[Abstract]
35. Chrabot CM, Prasad ML, Abcarian H. Recurrent anorectal abscesses. Dis Colon Rectum. 1983 Feb;26(2):105-8.[Abstract]
36. Hamalainen KP, Sainio AP. Incidence of fistulas after drainage of acute anorectal abscesses. Dis Colon Rectum. 1998 Nov;41(11):1357-61.[Abstract]
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