Anal abscess should visit which department?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 20, 2024
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Perianal abscess is a common disease in proctology, generally involving an infection of the local anal crypts and submucosal tissues near the anus. When a perianal abscess acutely flares, it is necessary to register with the department of coloproctology and undergo surgical treatment as soon as possible to prevent the abscess from expanding and leading to a systemic infection. The primary surgical treatment for perianal abscesses is a onetime radical surgery, but when there are changes resembling anal fistulas or leakage, options may also include incision, drainage, and seton procedures. After surgery, it is necessary to disinfect the local wound daily and ensure that the wound drainage is unobstructed.

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Written by Chen Tian Jing
Colorectal Surgery
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What is the internal opening of a perianal abscess?

The internal opening of a perianal abscess primarily refers to the anal crypt. It forms an infection site due to prolonged, repeated inflammatory infections, generally characterized by distinct pus discharge from the internal opening. Therefore, perianal abscesses tend to form a local internal opening near the anus along with intermittent pus discharge. If the perianal abscess acutely flares up or the pus cavity spreads, it might also rupture, causing pus to exit from an external opening, thereby leading to the formation of a typical anal fistula. During the acute phase of a perianal abscess, if there is local internal opening pain or pus discharge, it is recommended to seek surgical treatment as soon as possible. The primary method of surgery is aimed at radical treatment in one session. The principle involves opening the local pus cavity to allow for the discharge of pus, followed by a thorough debridement and removal of the local infection site. However, it is necessary to preserve the function of the local anal sphincter. If needed, a seton procedure may also be performed.

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Colorectal Surgery
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How to find the internal opening of a perianal abscess?

The internal opening of a perianal abscess is mainly identified through digital rectal examination and with the aid of a probe and perianal ultrasonography. Typically, during the onset of a perianal abscess, there is noticeable redness, swelling, heat, and pain around the anus. Inside the anal canal, digital rectal examination and anoscopy reveal swollen mucosa at the anal crypt, accompanied by the discharge of pus. Using a probe for exploration can clearly identify the presence of the internal opening locally. Once the internal opening of a perianal abscess is located, prompt surgical treatment is necessary. Surgery for perianal abscesses generally involves a one-time radical procedure complemented by incision and drainage. If an internal opening exists and involves the sphincter, further surgery involving incision, drainage, and seton placement may be required.

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Colorectal Surgery
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Why does a perianal abscess recur?

Perianal abscess is an infectious disease of the local skin and tissues around the anus caused by an infection in the anal crypts. If a perianal abscess is not treated with a definitive one-time surgical intervention, it is very likely to recur, or after rupture of the abscess, to form an anal fistula with long-term intermittent discharge of pus from an external opening. Therefore, during the acute phase of a perianal abscess, once a distinct abscess cavity and pus formation occurs, it is necessary to promptly perform a one-time definitive surgical treatment of the perianal abscess, rather than choosing conservative medication treatment or simple incision and drainage. The above treatments only temporarily alleviate symptoms of a perianal abscess; only a one-time definitive surgery that completely cleans the local wound can result in the complete healing of the perianal abscess.

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Colorectal Surgery
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How to treat recurrent perianal abscess?

If a perianal abscess has already been treated surgically, it is necessary to develop good dietary and bowel habits postoperatively to reduce the likelihood of recurrence. However, recurrence may still occur due to poor diet and bowel habits of the patient. If there is pain or discomfort at the site of the local wound of the perianal abscess, it is advisable to go to the hospital as soon as possible for an anal examination and perianal ultrasound to confirm if it has recurred. If it is confirmed to have recurred, early surgical treatment is necessary to prevent further expansion of the local infection focus or aggravation of the infection, which would increase the difficulty of treatment later.

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Can an anal abscess be left untreated without surgery?

Surgical treatment is required during the acute phase of a perianal abscess. If surgery is not performed, it could lead to an expansion of the abscess cavity or worsening of the infection. Severe cases may lead to a local cellulitis around the anus, forming an inflammation of the cellular tissue. The surgical approach for a perianal abscess primarily involves incision and drainage, complemented by a one-time radical cure. The surgical principle mainly involves excising the infected local lesions altogether, thoroughly disinfecting and dressing the area, accelerating the shedding of the local infection, and ensuring normal growth of granulation tissue. Postoperative dressing changes are also crucial for the recovery from a perianal abscess.