Perianal abscess

Question 1

Examination

Answer 1

Careful examination is essential to make the diagnosis.

Look for evidence of a;

• fistula
• Crohn disease
• anorectal cancer

Question 2

Treatment

Answer 2

Drainage via a deep cruciate incision over the point of maximal induration.

If abscess is recalcitrant or spreading with cellulitis use;

• metronidazole 400 mg (o) 12 hrly for 5–7 d
• • cephalexin 500 mg (o) 6 hrly for 5–7 d.