A 43-year-old man is seen in his physician's office for severe pain in the perineum. Examination reveals exquisite tenderness in the area to the right side of the anal verge due to a perianal abscess. Rectal examination is refused. What should be the next step in management?
The ducts of the anal glands drain into the anus and are covered by the vertical columns of Morgagni. Infection of these glands may account for some cases of perianal abscess. The folds end distally at about the level of the dentate line. The lower third of the anus receives its nerve supply from the pudendal nerve (somatic). In order to minimize spread of infection, the local anesthetic should be confined to the skin immediately overlying the abscess. This should be performed in a hospital setting, in an operating room, with good lighting, in the lithotomy position, using a combination of IV sedation and local anesthesia. Proctoscopy/sigmoidoscopy can be undertaken at the same time.
Drainage of the abscess in the office under local anesthesia.
Excision of the vertical fold of Morgagni.
Drainage under general anesthesia and immediate colonoscopy.
CT scan of the abdomen.
Small & Large Intestine