To drain infection of the soft tissue surrounding the rectum, which is caused by obstruction of the anal crypts and ducts
CONTRAINDICATIONS
Perianal abscesses with fistula-in-ano should be drained in the operating room (OR)
LANDMARKS
Most perianal abscesses form in the soft tissue adjacent to the anal sphincter
Ischiorectal, intersphincteric, external sphincter, and supralevator abscesses form internally underneath the subcutaneous tissue adjacent to the rectum (FIGURE 70.1)
General Basic Steps
Analgesia
Incision
Blunt dissection
Packing and dressing
TECHNIQUE
Supplies
Adhesive tape
1% Lidocaine with epinephrine (1:100,000)
25- and 22-guage needles, 10-mL syringes
FIGURE 70.1 Anorectal abscesses. (From Coates WC. Perianal, rectal, and anal diseases. In: Wolfson AB, ed. Harwood-Nuss’ Clinical Practice of Emergency Medicine. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2014:609, with permission.)
No. 11 scalpel blade
Hemostat
Saline
Sterile packing
4 × 4 gauze pads
Preparation
Consider mild oral sedative or anxiolytic for the patient before procedure
Place patient in the prone position
Separate buttocks with adhesive tape to the lateral aspect of the hip (FIGURE 70.2)
Analgesia
Infiltrate area around the abscess with 1% lidocaine with epinephrine (1:100,000)
Incision
Using a no.11 blade, a linear or elliptical incision is made over the most fluctuant part of the abscess
Express as much as possible from the abscess with gentle squeezing pressure (FIGURE 70.3)
Blunt Dissection
Explore abscess with a hemostat to break loculations
Irrigate the abscess with normal saline (FIGURE 70.4)
FIGURE 70.2 When excising a thrombosed external hemorrhoid or performing incision and drainage of an anal abscess, separate the buttocks by using 3-inch adhesive tape, as shown, to provide optimal exposure. (From Simon RR, Brenner BE. Emergency Procedures and Techniques. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:33, with permission.)
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