Download PDF
CC BY 4.0 · Journal of Coloproctology 2024; 44(04): e253-e260
DOI: 10.1055/s-0044-1800892
Original Article

Avoiding Recurrence of Anorectal Abscess: The Impact of Patient Delay in Seeking Medical Attention

Sonu Nimesh Patel
1   Department of Clinical Research, Axelrod Research Group, Jersey Shore University Medical Center, Neptune, New Jersey, United States
2   Department of Biological Sciences, Seton Hall University, South Orange, New Jersey, United States
,
Ria Elizabeth Philip
1   Department of Clinical Research, Axelrod Research Group, Jersey Shore University Medical Center, Neptune, New Jersey, United States
3   Department of Cell Biology and Neuroscience, Rutgers University, New Brunswick, New Jersey, United States
,
Dillon Downs
1   Department of Clinical Research, Axelrod Research Group, Jersey Shore University Medical Center, Neptune, New Jersey, United States
4   Department of Biological Sciences, Clemson University, Clemson, South Carolina, United States
,
Arthur Alan Topilow 
1   Department of Clinical Research, Axelrod Research Group, Jersey Shore University Medical Center, Neptune, New Jersey, United States
5   Department of Surgery, Office of Research Administration, Jersey Shore University Medical Center, Neptune, New Jersey, United States
,
Ramisa Anjum
6   Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey, United States
,
Glenn Scot Parker
6   Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey, United States
› Author Affiliations Funding This study was supported in part by the Herbert R. Axelrod Research Fund at the Jersey Shore University Medical Center. Thank you, Mila Lachica, BA, CCRP, for being the clinical coordinator for this study. Thank you, Nicole Lupo, PA-C, for providing us with the patient list. Thank you, Dr. Simon Gelman, M.S., Ph.D., for performing the statistical analyses.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective Anorectal abscess is a frequent surgical problem. The objective of our retrospective study is to determine the clinical factors that mitigate complications of anorectal abscesses.

Methods Data from a retrospective review of patients of one colorectal surgeon (GP) admitted and operated on for anorectal abscess at the Jersey Shore University Medical Center and Ocean University Medical Center between January 2019 and December 2022 were reviewed. Clinical information was obtained from medical records.

Results A total of 48 patients underwent surgery for drainage of anorectal abscess. After a physical examination, 48% of patients (23 of 48) received diagnostic imaging to confirm the nature and location of the abscess. Approximately 73% of patients (36 of 48) presented with an anorectal fistula upon evaluation. Of the 48 patients, thirty (63%) were diagnosed with a perianal abscess. The abscess in the other 18 of the 48 patients was in other areas of the anorectal region. Eleven patients developed a recurrent abscess after undergoing initial drainage. On average, recurrent patients waited 59 days before seeking initial treatment, whereas nonrecurrent patients waited ∼21 days.

Conclusion Patients who delay seeking medical attention are more likely to develop a recurrent abscess after receiving initial treatment. Diagnostic imaging with ultrasound and computed tomography significantly reduced transit time between the emergency room and the operating room. In both recurrent and nonrecurrent groups, no correlation was found between the size or location of the abscess and the chance of abscess recurrence.

Keywords

anal - rectal - abscess - treatment - evaluation

Authors' Contributions

Sonu Patel – Manuscript preparation, data collection, and review.

Ria Philip – Data collection.

Dillon Downs – Data collection.

Arthur Topilow – Contribution to data collection, encouragement of student review, director of student program, manuscript preparation, review, and IRB proposal.

Ramisa Anjum – Review of manuscript.

Glenn Parker – Project concept, manuscript review, provision of patient charts for review, and encouragement of students.




Publication History

Received: 25 July 2024

Accepted: 24 October 2024

Article published online:
18 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Abscess and Fistula Expanded Information. (2020) American Society of Colon and Rectal Surgeons
  • 2 Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg 2011; 24 (01) 14-21
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Liu CK, Liu CP, Leung CH, Sun FJ. Clinical and microbiological analysis of adult perianal abscess. Journal of Microbiology, Immunology, and Infection. Volume 44, Issue 3. 2011. Pages 204–208. ISSN 1684–1182. https://doi.org/10.1016/j.jmii.2011.01.024
    Crossref
  • 4 Whiteford MH. Perianal abscess/fistula disease. Clin Colon Rectal Surg 2007; 20 (02) 102-109
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Gaertner WB, Burgess PL, Davids JS. et al; Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum 2022; 65 (08) 964-985
    CrossrefPubMedSearch in Google Scholar
  • 6 Sigmon D, Emmanuel B, Tuma F. Perianal Abscess. StatPearls. National Library of Medicine. 2022
  • 7 Tarasconi A, Perrone G, Davies J. et al. Anorectal emergencies: WSES-AAST guidelines. World J Emerg Surg 2021; 16 (01) 48
    CrossrefPubMedSearch in Google Scholar
  • 8 Hamadani A, Haigh PI, Liu IL, Abbas MA. Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess?. Dis Colon Rectum 2009; 52 (02) 217-221
    CrossrefPubMedSearch in Google Scholar
  • 9 Bevans DW, Westbrook KC, Thompson BW, Caldwell FT. Perirectal abscess: A potentially fatal illness. The American Journal of Surgery, Volume 126, Issue 6. 1973. Pages 765–768. ISSN 0002–9610. https://doi.org/10.1016/S0002-9610(73)80067-4
    Crossref
  • 10 Vasilevsky CA, Gordon PH. The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum 1984; 27 (02) 126-130
    CrossrefPubMedSearch in Google Scholar
  • 11 Marcus RH, Stine RJ, Cohen MA. Perirectal abscess. Ann Emerg Med 1995; 25 (05) 597-603
    CrossrefPubMedSearch in Google Scholar
  • 12 Gnanadev R, Malkoc A, Nguyen A. et al. The Impact of Computed Tomography Scans on the Management and Wait Times in Perianal Abscess Diagnoses. Cureus 2023; 15 (11) e49417
    CrossrefPubMedSearch in Google Scholar
  • 13 Nottingham JM, Rentea RM. Anal Fistulotomy. StatPearls [Internet]. 2023. Bookshelf ID: NBK555998. PMID: 32310458
  • 14 Cianci P, Tartaglia N, Fersini A, Giambavicchio LL, Neri V, Ambrosi A. The Ligation of Intersphincteric Fistula Tract Technique: A Preliminary Experience. Ann Coloproctol 2019; 35 (05) 238-241
    CrossrefPubMedSearch in Google Scholar
  • 15 Yano T, Asano M, Matsuda Y, Kawakami K, Nakai K, Nonaka M. Prognostic factors for recurrence following the initial drainage of an anorectal abscess. Int J Colorectal Dis 2010; 25 (12) 1495-1498
    CrossrefPubMedSearch in Google Scholar
  • 16 Onaca N, Hirshberg A, Adar R. Early reoperation for perirectal abscess: a preventable complication. Dis Colon Rectum 2001; 44 (10) 1469-1473
    CrossrefPubMedSearch in Google Scholar
  • 17 Levy AD, Liu PS, Kim DH. et al; Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria® anorectal disease. J Am Coll Radiol 2021; 18 (11S): S268-S282
    CrossrefPubMedSearch in Google Scholar