The management of cryptoglandular anorectal abscesses – A snapshot of the local practice in Malta

Abstract text (incl. references and figure legends)

Introduction

Anorectal abscesses are a common surgical problem, most patients requiring drainage of the abscess and evacuation of source of sepsis. Despite being so common, locally there is no agreed common approach on management.

Method

Data collection was retrospective from surgical admission databases. 83 patients were admitted in 2020 with primary anorectal abscesses. 9 patients were excluded from the study as 3 were re-admitted with the same problem and 6 had inflammatory bowel disease.

Results

74 patients were included, 58 males and 16 females with a median age of 42 years. 10 patients had T2DM and 5 were immunocompromised. 3 patients were in the early post-operative period for perineal surgery.

All patients had a complete blood count and electrolytes taken whilst 21 (28.4%) had a serum glucose test. Prior to surgery, 14 (18.9%) had a CT scan whilst 3 (4.1%) had an MR performed. 1 (1.4%) patient had an US of the testes, which showed an incidental anorectal abscess. 14 (18.9%) patients had an MR in the post-op phase.

28 (37.8%) patients had antibiotics prior to admission, whilst all patients had antibiotics during admission. 72 (97.3%) patients underwent emergency incision and drainage (I&D), only 3 (4.1%) of which had a documented proctoscopy performed. 68 (91.9%) patients were prescribed antibiotics on discharge. 3 (4.1%) patients had no antibiotics on discharge and 3 (4.1%) patients completed a 7-day course as inpatients.

Conclusion

According to BMJ Guidelines, all patients with an anorectal abscess should have their white cell count, electrolytes and blood glucose checked. In our data, 53 (71.6%) patients did not have their glucose checked. Although use of antibiotics is not routinely recommended in patient with anorectal abscess, all patients were given antibiotics on admission and 68 (91.9%) patients also on discharge.

References

Whiteford M, Hyman N, Brown S. (2021). Anorectal abscess - Symptoms, diagnosis and treatment. BMJ Best Practice US.

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