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Perirectal Abscess, Emergency Medicine

James A. Nelson and Scott A. Miller Reviewed 06/2017
 


Basics

Description

Localized infection and accumulation of purulent material adjacent to anus or rectum 

Etiology

  • Anal crypt gland infection, with spread to adjacent areas separated by muscle and fascia:

    • ...

Diagnosis

Signs and Symptoms

  • Pain: Perianal, rectal, or pelvic

  • Swelling, fluctuance, drainage, fever

History

  • Perianal pain:

    • Aggravated by defecation, sitting, coughing

  • Dull deep pelvic or rectal pain:

    • Less p...

Treatment

Initial Stabilization/Therapy

Pain medication 

Ed Treatment/Procedures

  • Delayed drainage may worsen outcome

  • Bedside drainage:

    • Only if localized perianal abscess

      • Probe to rule out deeper tract

    • Radial...

Follow-Up

Disposition

Admission Criteria

  • Need for operative drainage

  • Systemic toxicity/signs of sepsis

Discharge Criteria

Adequate I&D with complete drainage 

Issues for Referral

All should be referred t...

Pearls and Pitfalls

  • Be certain of extent of abscess:

    • Thorough rectal exam and probing is mandatory.

    • Imaging adds insight into deeper areas not accessible to exam

  • Deeper abscesses above dentate line have ...

Additional Reading

  • Marcus  RH, Stine  RJ, Cohen,  MA. Perirectal abscess. Ann Emerg Med.  1995;25(5):597–603.

  • Rizzo  JA, Naig  AL, Johnson  EK. Anorectal abscess and fistula-in-ano: Evidence-based...

Codes

ICD9

  • 565.1 Anal fistula

  • 566 Abscess of anal and rectal regions

ICD10

  • K61.0 Anal abscess

  • K61.1 Rectal abscess

  • K61.3 Ischiorectal abscess

  • K60.4 Rectal fistula

SNOMED

  • 91669008 Perirectal abscess (disorder)

  • 3...

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