Updates in the Management of Anorectal Abscess and Inflammatory or Thrombotic Process

Thrombosis and inflammation are common causes of anorectal emergencies. Anorectal suppuration can lead to live-threatening disease (Fournier Gangrene) if is not treated immediately. Formation of subsequent fistula is rare after sufficient drainage. Abscesses caused by acne inversa are in most cases chronic suppurative lesions in the anorectal region without fistulation to the anal canal. Definitive treatment consists in radical surgical excision. Thrombosis of hemorrhoidal or anal vein is very painful, but can be managed conservatively in most cases. Local excision can be considered in patient with large segmental thrombosis and short-time duration. Acute abscess may be a first clinical manifestation of pilonidal sinus. At an acute stage, only local limited drainage of the abscess should be performed. Definitive surgery should be consist in excision with primary closure by an off-midline procedure.