Treatment is surgical and should be performed as soon as the diagnosis is made, before the abscesses become fluctuant. Drainage should be both early and extensive. All perirectal abscesses should be drained in the operating room. A recent publication revealed that 32 percent of patients who had undergone a simple incision and drainage under local anesthesia were required to have a second operation because of inadequate drainage and recurrence of disease.

Isolated, simple, fluctuant perianal abscesses that are not associated with the presence of any deeper abscesses may be drained using local anesthetics in an ED setting. The local anesthetic should be administered with the finest-gauge needle available (30-gauge) and should be complemented with the administration of systemic analgesia or conscious sedation. To ensure adequate drainage, a cruciate incision should be made over the fluctuant part of the abscess, and the "dog ears"

resulting from the cruciate incision should be excised so as to prevent premature closure of the cutaneous wall of the abscess ( Fig 78-6). No packing is required, but the wound should be covered with a bulk dressing; sitz baths should be started the next day. If a simple, linear drainage incision is made, the abscess is more likely to recur because of premature closure of skin edges. Whenever this technique is used the abscess cavity must be packed initially with strips of gauze for at least 24 h. These patients will require closer follow-up care.

As a rule, antibiotics are not necessary after an abscess has been adequately drained. On the other hand, patients whose immune system may be compromised by diabetes mellitus, AIDS, malignancies, and chemotherapy and/or those patients who have extensive cellulitis should be given broad-spectrum antibiotics.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

Get My Free Ebook

Post a comment