How to Drain an Abscess

Abstract

Anorectal abscesses belong to the most frequent emergency worldwide with an estimated 500,000 new anorectal abscesses in Europe and North America, which is roughly similar to the number of appendectomy performed in these countries. It may affect anybody and originate mostly from obstructed cryptoglandular tissue. Fistula complicates about 25–50% of abscess, while life-threatening sepsis remains exceptional. Swift diagnosis and treatment are important to avoid unneeded suffering and depend on history taking and clinical examination, followed by a prompt drainage procedure. The Park’s classification is useful to document and guide therapy. Adequate surgical drainage and debridement are paramount, considering that almost half of anorectal abscesses relapse within 1 year of drainage. Most anorectal abscess can be drained and debrided with a single radial incision in an outpatient setting. A fistula is frequently found either at diagnosis or during early follow-up: It can be drained with a seton and referred to specialized treatment once inflammation has subsided or left alone as many will heal spontaneously. Routine management of postoperative care is important as secondary wound healing is the rule. Wound cleaning thrice daily with tap water is enough, and antibiotics postdrainage are rarely required. Last but not least, thorough information and counseling of the patient are required to optimize perioperative compliance and outcome.