Perianal Abscess: Incision and Drainage

imagesTo drain infection of the soft tissue surrounding the rectum, which is caused by obstruction of the anal crypts and ducts


CONTRAINDICATIONS



imagesPerianal abscesses with fistula-in-ano should be drained in the operating room (OR)


LANDMARKS



imagesMost perianal abscesses form in the soft tissue adjacent to the anal sphincter


imagesIschiorectal, intersphincteric, external sphincter, and supralevator abscesses form internally underneath the subcutaneous tissue adjacent to the rectum (FIGURE 70.1)



imagesGeneral Basic Steps


   imagesAnalgesia


   imagesIncision


   imagesBlunt dissection


   imagesPacking and dressing


TECHNIQUE



imagesSupplies


   imagesAdhesive tape


   images1% Lidocaine with epinephrine (1:100,000)


   images25- and 22-guage needles, 10-mL syringes



images


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.)


   imagesNo. 11 scalpel blade


   imagesHemostat


   imagesSaline


   imagesSterile packing


   images4 × 4 gauze pads


imagesPreparation


   imagesConsider mild oral sedative or anxiolytic for the patient before procedure


   imagesPlace patient in the prone position


   imagesSeparate buttocks with adhesive tape to the lateral aspect of the hip (FIGURE 70.2)


imagesAnalgesia


   imagesInfiltrate area around the abscess with 1% lidocaine with epinephrine (1:100,000)


imagesIncision


   imagesUsing a no.11 blade, a linear or elliptical incision is made over the most fluctuant part of the abscess


   imagesExpress as much as possible from the abscess with gentle squeezing pressure (FIGURE 70.3)


imagesBlunt Dissection


   imagesExplore abscess with a hemostat to break loculations


   imagesIrrigate the abscess with normal saline (FIGURE 70.4)



images


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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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Perianal Abscess: Incision and Drainage
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