Anal Examination Under Anesthesia with Abscess Drainage and Evaluation for Fistula
Jennifer Shearer, MD; Brooke Gurland, MD, FACS
Stanford University School of Medicine

Anorectal abscesses most commonly result from obstruction of glandular crypts in the anorectal canal. Abscesses are commonly diagnosed by clinical exam with fluctuance, induration, and tenderness around the perianal tissue.

Abscesses are managed with incision and drainage. For superficial perianal abscesses, bedside lancing can be performed, but for more complex or ischiorectal or postanal abscess, examination under anesthesia in the operating room is preferred. Complete evacuation of the abscess with breakdown of loculated abscess pockets is critical to fully control the infection. Drains may also be left in a deep abscess pocket to prevent the skin prematurely closing before the cavity has healed.

Imaging is selectively performed with CT or MRI to identify occult infections or further identify proximal extent of abscess cavity or associated fistula. For recurrent abscesses, associated fistula tracts should also be identified and, if possible, treated intraoperatively. Antibiotics are utilized for patients with cellulitis or those who are immunosuppressed. This video article presents an adult male with recurrent anorectal abscesses with a new anterior abscess collection, which was managed with anal exam under anesthesia with incision and drainage of abscess collection and drain placement.