Keywords

Preference Card

  • Hill-Ferguson retractor

  • Local anesthetic for subcutaneous and submucosal infiltration

  • Number 11 blade scalpel

  • Cut down tray

  • Suction

  • Irrigation with bulb syringe

Patient Positioning/Operating Room Setup

  • Place patient in prone jackknife position, on a Kraske roll (see Fig. 22.1).

  • Ensure that all pressure points are padded.

  • Secure patient to the operating room table.

  • Tape the buttock apart to expose the anus.

  • Prep and drape the perianal region.

Nodal Points

Type of Incision

  • Cruciate or elliptical incision over the fluctuating area of the abscess

Procedure Steps

  • Incise the skin.

  • Evacuate purulent fluid.

  • Culture the fluid.

  • Divide any septations within the abscess cavity to ensure adequate drainage.

  • Irrigate the cavity repeatedly with normal saline.

  • Pack the cavity with sterile gauze.

  • Leave the wound open and apply dressings.

Pearls and Pitfalls

  • Abscesses are classified as (A) perianal (60%), (B) ischiorectal (20%), (C) intersphincteric (10%), or (D) supralevator (9%), depending on their location (Fig. 24.1).

  • Cruciate or elliptical incision should be wide enough to ensure appropriate drainage of the abscess cavity.

  • If the abscess cavity is deep a mushroom catheter may be left in place and secured with Silk.

  • Intersphincteric abscesses are managed by unroofing the abscess cavity by performing an internal sphincterotomy (similar to description below for fissure in ano).

  • Horseshoe abscesses require division of the anococcygeal ligament with counter-incisions overlying the abscess in the ischiorectal fossae.

Fig. 24.1
figure 1

Abscess classification: (a) perianal, (b) ischiorectal, (c) intersphincteric, and (d) supralevator

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