-
Primary Care Mar 2022An abscess is a localized collection of purulent material surrounded by inflammation and granulation in response to an infectious source. Most simple abscesses can be... (Review)
Review
An abscess is a localized collection of purulent material surrounded by inflammation and granulation in response to an infectious source. Most simple abscesses can be diagnosed upon clinical examination and safely be managed in the ambulatory office with incision and drainage. Wound culture and antibiotics do not improve healing, but packing wounds larger than 5 cm may reduce recurrence and complications.
Topics: Abscess; Anti-Bacterial Agents; Anus Diseases; Drainage; Humans
PubMed: 35125157
DOI: 10.1016/j.pop.2021.10.002 -
BMJ (Clinical Research Ed.) Feb 2017
Review
Topics: Abscess; Adult; Anal Canal; Anus Diseases; Bacterial Infections; Female; Humans; Incidence; Male; Rectal Fistula; Risk Factors; United Kingdom
PubMed: 28223268
DOI: 10.1136/bmj.j475 -
European Journal of Pediatric Surgery :... Oct 2020Perianal abscess (PA) and fistula-in-ano (FIA) are common entities in infancy. Although several hypotheses have been suggested, the pathogenesis of PA/FIA remains... (Review)
Review
Perianal abscess (PA) and fistula-in-ano (FIA) are common entities in infancy. Although several hypotheses have been suggested, the pathogenesis of PA/FIA remains elusive. The natural course of these diseases in infancy is self-limiting in the majority of cases whereas older children show similarities to PA/FIA in adults. It is important to rule out rare differential diagnoses of PA/FIA such as inflammatory bowel disease (IBD), surgical complications after colorectal surgery, and immunodeficiencies. Treatment remains empiric, comprises conservative, as well as surgical approaches, and is dependent on the age of the patient. This review summarizes anatomical aspects, current evidence on disease pathogenesis, clinical presentation, and management of pediatric patients with PA and FIA.
Topics: Abscess; Adolescent; Child; Child, Preschool; Conservative Treatment; Diagnosis, Differential; Female; Fissure in Ano; Humans; Infant; Male; Rectal Fistula; Surgical Procedures, Operative
PubMed: 32987435
DOI: 10.1055/s-0040-1716726 -
The American Journal of Gastroenterology Aug 2023Perianal Crohn's disease affects 25%-35% of patients with Crohn's disease and has proven to be one of the most difficult complications of the disease to treat. Patients... (Review)
Review
Perianal Crohn's disease affects 25%-35% of patients with Crohn's disease and has proven to be one of the most difficult complications of the disease to treat. Patients with perianal Crohn's disease have lower health-related quality of life scores typically related to pain and fecal incontinence. In addition, patients with perianal Crohn's disease have higher rates of hospitalizations, surgeries, and overall healthcare costs. A multidisciplinary approach is necessary for the successful management of Crohn's disease with perianal fistula. Medical management is required to treat the underlying immune dysregulation to heal the luminal inflammation and the inflammation within the fistula tracts. Current options for medical therapy include biologics, dual therapy with thiopurines, therapeutic drug monitoring, and a close follow-up. Surgical management is critical to drain abscesses before immunosuppressive therapy and place setons when appropriate. Once the patient's inflammatory burden is well managed, definitive surgical therapies including fistulotomies, advancement flaps, and ligation of intersphincteric fistula tract procedures can be considered. Most recently, the use of stem cell therapy in the treatment of perianal fistula has given new hope to the cure of perianal fistula in Crohn's disease. This review will outline the most current data in the medical and surgical management of perianal Crohn's disease.
Topics: Humans; Crohn Disease; Quality of Life; Rectal Fistula; Fecal Incontinence; Abscess; Treatment Outcome
PubMed: 37207318
DOI: 10.14309/ajg.0000000000002326 -
American Family Physician Jan 2020Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rectal pain, perianal abscess, condyloma, rectal prolapse, and fecal... (Review)
Review
Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rectal pain, perianal abscess, condyloma, rectal prolapse, and fecal incontinence. Although these are benign conditions, symptoms can be similar to those of cancer, so malignancy should be considered in the differential diagnosis. History and examination, including anoscopy, are usually sufficient for diagnosing these conditions, although additional testing is needed in some situations. The primary treatment for hemorrhoids is fiber supplementation. Patients who do not improve and those with large high-grade hemorrhoids should be referred for surgery. Acutely thrombosed external hemorrhoids should be excised. Perianal pruritus should be treated with hygienic measures, barrier emollients, and low-dose topical corticosteroids. Capsaicin cream and tacrolimus ointment are effective for recalcitrant cases. Treatment of acute anal fissures with pain and bleeding involves adequate fluid and fiber intake. Chronic anal fissures should be treated with topical nitrates or calcium channel blockers, with surgery for patients who do not respond to medical management. Patients with functional rectal pain should be treated with warm baths, fiber supplementation, and biofeedback. Patients with superficial perianal abscesses not involving the sphincter should undergo office-based drainage; patients with more extensive abscesses or possible fistulas should be referred for surgery. Condylomata can be managed with topical medicines, excision, or destruction. Patients with rectal prolapse should be referred for surgical evaluation. Biofeedback is a first-line treatment for fecal incontinence, but antidiarrheal agents are useful if diarrhea is involved, and fiber and laxatives may be used if impaction is present. Colostomy can help improve quality of life for patients with severe fecal incontinence.
Topics: Anus Diseases; Diagnosis, Differential; Evidence-Based Medicine; Female; Humans; Male; Practice Guidelines as Topic
PubMed: 31894930
DOI: No ID Found -
Techniques in Coloproctology Feb 2020Perianal sepsis is a common condition ranging from acute abscess to chronic anal fistula. In most cases, the source is considered to be a non-specific cryptoglandular...
Perianal sepsis is a common condition ranging from acute abscess to chronic anal fistula. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. Surgery is the main treatment and several procedures have been developed, but the risks of recurrence and of impairment of continence still seem to be an unresolved issue. This statement reviews the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.
Topics: Abscess; Anus Diseases; Humans; Rectal Fistula; Sepsis; Skin Diseases; Treatment Outcome
PubMed: 31974827
DOI: 10.1007/s10151-019-02144-1 -
The British Journal of Surgery Sep 2022Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim of this randomized clinical trial (RCT) was to assess if non-packing is less painful and if it is associated with adverse outcomes.
METHODS
The Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial was a multicentre, RCT (two-group parallel design) of adult participants admitted to an NHS hospital for incision and drainage of a primary perianal abscess. Participants were randomized 1:1 (via an online system) to receive continued postoperative wound packing or non-packing. Blinded data were collected via symptom diaries, telephone, and clinics over 6 months. The objective was to determine whether non-packing of perianal abscess cavities is less painful than packing, without an increase in perianal fistula or abscess recurrence. The primary outcome was pain (mean maximum pain score on a 100-point visual analogue scale).
RESULTS
Between February 2018 and March 2020, 433 participants (mean age 42 years) were randomized across 50 sites. Two hundred and thirteen participants allocated to packing reported higher pain scores than 220 allocated to non-packing (38.2 versus 28.2, mean difference 9.9; P < 0.0001). The occurrence of fistula-in-ano was low in both groups: 32/213 (15 per cent) in the packing group and 24/220 (11 per cent) in the non-packing group (OR 0.69, 95 per cent c.i. 0.39 to 1.22; P = 0.20). The proportion of patients with abscess recurrence was also low: 13/223 (6 per cent) in the non-packing group and 7/213 (3 per cent) in the packing group (OR 1.85, 95 per cent c.i. 0.72 to 4.73; P = 0.20).
CONCLUSION
Avoiding abscess cavity packing is less painful without a negative morbidity risk.
REGISTRATION NUMBER
ISRCTN93273484 (https://www.isrctn.com/ISRCTN93273484).
REGISTRATION NUMBER
NCT03315169 (http://clinicaltrials.gov).
Topics: Abscess; Adult; Anus Diseases; Bandages; Drainage; Humans; Pain; Rectal Fistula; Treatment Outcome
PubMed: 35929816
DOI: 10.1093/bjs/znac225