Last reviewed:October 2019
Last updated:September  2019

Summary

Definition

History and exam

Key diagnostic factors

  • anal fistula
  • history of Crohn's disease
  • male sex
  • perianal pain
  • perianal or rectal induration

Other diagnostic factors

  • perianal swelling
  • low-grade fever
  • tachycardia
  • change in bowel habits
  • rectal bleeding
  • inability to urinate

Risk factors

  • anal fistula
  • Crohn's disease
  • male sex
  • hard stools
  • age 20 to 40 years

Diagnostic investigations

1st investigations to order

  • clinical examination
  • examination under anaesthetic
Full details

Investigations to consider

  • WBC count
  • serum glucose
  • serum electrolytes
  • anal ultrasonography
  • CT pelvis
  • MRI pelvis
  • microscopic examination and/or culture of the purulent fluid
Full details

Treatment algorithm

Contributors

Professor of Surgery

Chief

Section of Colorectal Surgery

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JR is an author of a reference cited in this topic.

Dr Jan Rakinic would like to gratefully acknowledge Dr C. Neal Ellis, a previous contributor to this topic. CNE declares that he has no competing interests.

Peer reviewersVIEW ALL

Assistant Professor of Surgery

Colon and Rectal Surgery

Gastrointestinal and Minimally Invasive Surgery Division

The Oregon Clinic

Portland

OR

Disclosures

MHW declares that he has no competing interests.

Chief

Division of General Surgery

Professor of Surgery

Fletcher Allen Healthcare

Burlington

VT

Disclosures

NH declares that he has no competing interests.

Consultant Surgeon

Department of Colorectal Surgery

Sheffield Teaching Hospitals

Sheffield

UK

Disclosures

SB declares that he has no competing interests.

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