Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Peripheral Neuropathies Perirectal Abscesses and Fistulas 1157

■Local treatment to minimize pressure damage for entrapment

neuropathy; surgical decompression sometimes needed

follow-up

■Depends on individual disorder

complications and prognosis

■Depend on individual disorder

PERIRECTAL ABSCESSES AND FISTULAS

MARK A. VIERRA, MD

history & physical

Abscess

■Rectal pain most common presenting symptom.

■Pain tends to be of relatively short duration (hours or days), pro-

gressive, and present continuously, rather than pain only with bowel

movements, as occurs with a fissure

■Tenderness, swelling, induration, fluctulence usually, but not always

present

■Complicated abscesses may require examination under anesthesia

for diagnosis

■Fever and leukocytosis unreliably present

Fistula

■Following drainage 25%–50% of abscesses will go on to persist as a

fistula

■Not usually painful, though may develop recurrent abscesses at the

site

■Small external opening with mucoid or prurulent drainage is usually

easily visible

tests

Laboratory Tests

■Anorectal abscesses or fistulas complicated by abscess may be

accompanied by leukocytosis, though this is variable

■CT scan or endorectal ultrasound may very rarely be necessary to

delineate abscess or fistula

■Barium enema or fistulogram may be necessary to delineate complex

fistulas