0071643192.pdf

COMPLICATIONS

■ Bowel perforation carries up to 40% risk of mortality.
■ Acute colitis may occur due to bowel ischemia.

ANORECTAL

Perianal/Anal Abscess

Common in middle-aged males

SYMPTOMS/EXAM

■ Easily palpable tender mass, close to the anal verge, usually posterior midline
■ Pain may be worse before defecation and with valsalva maneuvers.

DIFFERENTIAL/DIAGNOSIS

■ Crohn’s disease, fissures, cancer, pilonidal disease, hidradenitis suppura-
tiva, cancer, STDs.
■ CT or ultrasound to assess rectal involvement.

TREATMENT

■ Isolated and fluctuant abscesses may be drained in the ED. Use a cruciate
incision (+/– packing) so that wound edges do not close. Simple linear
incisions may be used but require packing and 24-hour follow-up.
■ Antibiotics as a rule are not necessary but should be used with fever,
leukocytosis, overlying cellulitis, or in immunocompromised patients.
■ Warm sitz baths

COMPLICATIONS

Recurrence, fistulas, sphincter injury, sepsis

Perirectal Abscess

SYMPTOMS/EXAM

■ See Figure 11.5 for common locations of perirectal abscesses.
■ Ischiorectal abscess: Dull pain with few outward signs; signs may be more
lateral to anal verge than perianal abscess
■ Intersphincteric abscess: Pain with defecation, rectal discharge, fever, mass
on rectal exam
■ Supralevator abscess: Buttock or perirectal pain; few outward signs

DIAGNOSIS

CT/US/MRI to determine the extent of tissue involvement

TREATMENT

■ Surgical consult: All perirectal abscesses should be drained in the operating
room because of the high incidence of recurrence.
■ Daily warm sitz baths; antibiotics

COMPLICATIONS

Recurrence, fistulas, sphincter injury, sepsis

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES