Steps for drainage of perianal abscess

Perianal abscess drainage is actually a treatment through surgical drainage. Because the incidence of perianal abscess is getting higher and higher, seriously affecting the patient's life and work, we can also learn more about the surgical steps and methods of perianal abscess drainage.

1. Incision and drainage of perianal subcutaneous abscess

Lithotomy or lateral decubitus position. Make radial incisions at the perianal abscess, with the length equal to the size of the abscess cavity. After the skin is cut, use hemostatic forceps for blunt separation to enter the abscess cavity and drain the pus. Then, insert your fingers into the abscess cavity to detect its size and separate the fibrous septa in the abscess cavity (if the subcutaneous group of the external anal sphincter hinders drainage, it can be cut off, but its deep layer should not be damaged). After expanding the incision as needed, cut off a little skin at the edge of the incision to ensure smooth drainage. Finally, the necrotic tissue in the cavity was removed and vaseline gauze was placed inside the abscess cavity for drainage.

In order to avoid the formation of fistulas in the future, after opening the abscess, the inflamed crypt (i.e., the internal opening) should be found, and the tissue between it and the incision should be cut to ensure smooth drainage. If the internal opening is above the anorectal ring, it is not necessary to make an incision. Instead, a staged surgery is appropriate. A silk thread can be passed through the internal opening and the incision can be made when the fistula is formed 2 to 3 weeks later.

2. Incision and drainage of rectal submucosal abscess

If the abscess is located in the upper rectum, no anesthesia is required; if the abscess is close to the dentate line, local anesthesia or saddle anesthesia is appropriate because of the sensitivity to pain. Insert an anal retractor, and after finding the abscess, use a sharp-edged knife to puncture the mucosa at the raised part of the abscess and drain the pus. Then use hemostatic forceps to bluntly enlarge the incision longitudinally (to the same size as the abscess cavity), remove the necrotic tissue, and do not place drainage.

3. Incision and drainage of sciatic rectal abscess?

In the area with fluctuation, make a straight front-to-back incision or a slightly curved incision. The incision should be as close to the anus as possible, but at least 2.5 cm away from the anus to avoid damaging the anal sphincter. After the skin is incised, use hemostatic forceps to bluntly enter the abscess cavity and drain the pus. Insert the index finger, explore the scope of the abscess cavity, separate the fibrous septa in the abscess cavity, and expand the incision in the anterior and posterior directions according to the scope of the abscess. The sciatic rectal space can accommodate 60 to 90 ml of pus. If more than 90 ml of pus is discharged during surgery, it should be considered that it is connected with the contralateral sciatic rectal space or the pelvic rectal space above it. After diagnosis, they must be drained separately. Trim any protruding wound edges. After the bleeding stops, insert a Vaseline gauze strip for drainage.

4. Pelvic rectal space abscess incision and drainage

The operation is roughly the same as the incision and drainage of ischiorectal space abscess, but the incision must be biased toward the posterolateral side of the anus and made in the anterior-posterior direction 2.5 cm away from the anal margin. After the hemostat is inserted into the ischiorectal space, insert the index finger of the left hand into the rectum to guide the hemostat deeper. When the hemostatic forceps reaches the levator ani muscle, you can feel the muscle strength. After passing the levator ani muscle with the tip of the forceps, continue to insert it about 1 cm, and pus will flow out. Then open the hemostat and enlarge the drainage port on the levator ani muscle. After the pus is drained, the protruding edges on both sides of the wound are removed and a cigarette is placed in the abscess cavity for drainage.