presented by Dr. Ken Adams
For the ED physician, one of our primary concerns if whether this is something that we can handle or does it require surgical management. We should feel comfortable managing perirectal abscesses but the collections in other anorectal areas such as the intersphincteric, ischiorectal and supralevator spaces require surgical management.
The most feared complication is fistula formation which can form in anywhere between 30 – 60% of anorectal abscesses. If you are going to perform an I&D of an anorectal abscess in the ED, taking a culture is of utmost importance. If the culture is growing common GI flora (Bacteroides, E. coli, Enterobacterstaph) you should be suspicious for an underlying fistula while you can feel more comfortable if your culture comes back with staph or strep as this is likely your run of the mill abscess. Incision and drainage is the definitive treatment but you should consider antibiotics if they patient displays systemic symptoms, is a diabetic or is immunosuppressed.