Examination and treatment of anorectal abscesses, recommended by WSES guidelines at a glance!

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Anorectal emergencies include a variety of disorders that share a common symptom, namely anorectal pain or bleeding that may require immediate treatment. In 2021, the World Society of Emergency Surgery (WSES) and the American Society of Trauma Surgery (AAST) jointly published guidelines for the management of anorectal emergencies, with the goal of raising clinicians' awareness of these conditions and providing guidance for emergency management of anorectal emergencies. For the management of anorectal abscesses, the guidelines mainly recommend the following recommendations.

Clinical examination and biochemical examination

For patients with suspected anorectal abscess, it is recommended to take a key history and perform a complete physical examination, including a digital rectal examination. （2C）

In patients with suspected anorectal abscess, it is recommended to check serum blood glucose, glycosylated hemoglobin, and urine ketones to identify undetected diabetes. （1C）

For patients with suspected anorectal abscess and symptoms of systemic infection or sepsis, testing for a complete blood count, serum creatinine, and inflammatory markers (e.g., C-reactive protein, procalcitonin, and lactate) is recommended to assess patient status. （2C）

Imaging studies

Imaging is performed in patients with suspected anorectal abscess and suspected occult levator ani abscess, complex fistula, or perianal Crohn's disease. MrI, CT, or endoscopy is recommended depending on the specific clinical situation and available techniques and resources. （2C）

treat

In patients with anorectal abscess, incision and drainage are recommended. （1C）

For patients with anorectal abscess, it is recommended to determine the timing of surgery based on the presence and severity of sepsis. （2C）

In immunocompetent patients with small perianal abscesses and no signs of systemic sepsis, it is recommended to consider outpatient treatment. （2C）

According to the available literature, there is no recommendation for the use of fillers after drainage of anorectal abscesses.

For patients with anorectal abscess and an obvious fistula, it is recommended to perform fistula infiltration at the time of abscess drainage only in the case of a low fistula that does not involve the sphincter (e.g., subcutaneous fistula). （2C）

In patients with anorectal abscess and a significant fistula involving any sphincter, an immobilized drainage cable is recommended. （2C）

In patients with anorectal abscess without an obvious fistula, it is not recommended to explore for possible fistulas to avoid iatrogenic complications. （2C）

For patients with anorectal abscess, antibiotics are recommended in case of sepsis and / or infection of the surrounding soft tissues or disorders of the immune response. （2C）

For patients with anorectal abscess, abscess sampling is recommended in patients at high risk and/or in the presence of risk factors for multidrug-resistant microbial infection. （2D）