Perianal Abscess – Incision and Drainage

Procedure Snapshot

• Indication: Fluctuant perianal abscess.
• Expected duration: ___
• Special instruments: Scalpel, mosquito clamps, packing.

Step Workflow

1. Lithotomy or prone jackknife.
2. Palpate and incise closest to point of fluctuance.
3. Break loculations; irrigate.
4. Leave open for drainage or place loose seton if tract identified.

Key Pimp Questions

• Q: Most common etiology? A: Cryptoglandular.
• Q: Antibiotics? A: Only if cellulitis or immunosuppressed (PMID 30337355).

Critical Anatomy

• Landmarks: Anal margin, ischiorectal fossa.
• Danger zones: Sphincter complex.

Informed Consent Highlights

• Pain, recurrence, fistula formation.

Post-op Considerations

• Sitz baths, stool softeners.

References

• Chassin’s, Anorectal. Clinical Scenarios, Anorectal.
• Abcarian 2011 (PMID 21422422).