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Perianal Abscess and Fistula Surgery

The treatment is surgical. It is emergency surgery, life-saving but straightforward for the patient. It involves making a window or hole in the skin that will communicate with the abscess space. It will be drained and cured with antiseptic liquids.

What are anorectal (perianal) abscesses?

They are infections of the anal glands located at the end of the rectum. They have a duct that carries their secretion to the outside, in the anorectal area. If this duct becomes clogged, mucus begins to accumulate, bacteria reproduce immediately, and an infection of the entire gland is created.

Dr. Víctor Calao

Dr. Víctor Calao

Specialist in the timely diagnosis and immediate treatment of diseases of the gastrointestinal tract.

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These are some of the FAQs about Abscess and Perianal Fistula Surgery

Patients initially feel mild pain or itching in the perianal area. The pain increases, and they begin to notice a localized enlargement or a painful “lump.” It may even cause pain when sitting. If the patient does not see a doctor and lets it go, fever, chills, shivering, and pain become unbearable.

Anorectal abscesses are called primary or non-specific when they have a cryptoglandular cause and secondary or specific when related to other diseases.

Several theories are known, the most accepted being infection of the gland due to obstruction. Anal crypts are folds of the rectal mucosa where the glandular ducts are discharged. Anal crypts can become obstructed by trauma, foreign bodies, or fecal matter.

Infectious material from the feces enters the crypts, which funnel the material into the glands. Subsequently, the infection spreads to the perianal or perirectal tissues or both. Finally, an abscess forms in some of the perianal or perirectal spaces. There are also other factors involved, such as the aggressiveness of the infecting bacteria or the patient’s immune status.

The other secondary causes of perianal abscess formation are Chron’s disease, tuberculosis, trauma, previous anorectal surgery, anal or rectal cancer, radiation, lymphomas, and leukemias.

Once there are symptoms in the perianal area, the patient should go directly to a certified general surgeon for examination. This is emphasized because the specialist will identify it the first time, will not require further studies unless the abscess is very deep and makes few changes on the surface.

Much importance is given to the time to implement treatment because the purulent material spreads rapidly and can affect the entire perineum (the area between the anus and the genitals). There have been patients in whom the infection goes up to the testicles, labia majora, and anterior abdominal wall. More severe conditions are common in patients with obesity, immunosuppressed, or uncontrolled (untreated) diabetes mellitus.

The treatment is surgical. It is simple emergency surgery, but it saves the patient’s life. It involves making a window or hole in the skin that will communicate with the abscess space. It will be drained and cured with antiseptic liquids. The procedure is performed under local anesthesia in the office.  A criss-cross incision is made, and then the lugs are cut. This allows the skin to be kept open so that drainage is continuous and is aided by daily dressings with surgical soap or other antiseptics.

Once the emergency is drained and removed, treatment will continue on an outpatient basis with daily dressings and antibiotics for 10 to 14 days. Anti-inflammatory drugs, stool softeners, a high fiber diet, and daily intake of 2 liters of water per day.

You will have to continue with the cures and sitz baths. It is essential to maintain extreme hygiene in the area, wash after going to the bathroom. Take your medications as indicated by your surgeon. If you have diabetes, you must control the disease, go to an internist to assess your blood studies and the figures of glucose and lipids, and apply improvements to treatment.

A diet high in fiber, vegetables, and fruits, preferably salads. Your surgeon will indicate the consumption of fiber supplements such as Psyllium Plantago, which facilitates intestinal transit.

The questioning and physical examination performed by a surgeon is extremely valuable. It is reinforced with laboratory studies and confirmed with imaging studies such as ultrasound or tomography. The latter is very useful in cases of women where the internal reproductive organs are located close to the appendix and may be the cause of the pain.

After an abscess and perianal fistula surgery, it is possible since there is not only a gland in the region. As we mentioned, 30% of patients already have a history of an anorectal abscess.

Because the wound is left open to continue healing, complete healing will take approximately 2 to 4 weeks. It is longer in diabetic patients.

It is more frequent in men than in women in a 3:1 ratio. The highest incidence occurs in the third and fourth decades of life. In approximately 30% of patients with anorectal abscesses, there is a previous history of similar abscesses resolved spontaneously with surgical treatment.

A higher incidence of abscesses and fistulas has been seen during hot seasons such as spring and summer.

We have observed that our patients are generally men 35 years of age or older, overweight or obese, most of them with diabetes mellitus, and spend long hours sitting at work related to driving.
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