A 50-year-old male comes in to the emergency department complaining of unremitting pain in an area of his right buttock near the anus. Although he is uncertain when the discomfort first began, he notes that the pain has increased significantly over the past 24 hours. He finds he is unable to pass stool because of the pain. He has not experienced symptoms like this before. Ten years ago, he was diagnosed with diabetes mellitus. He is currently on insulin. He smokes half a pack of cigarettes per day but would like to quit. He denies drinking alcohol or using recreational drugs. His temperature is 38.1C (100.6F), blood pressure is 128/86 mm Hg, and pulse is 90/min. There is a hot, tender, mass located between the anus and the left ischial tuberosity. The mass fluctuates upon palpation.
The patient is treated appropriately. To minimize risk of complications, he is advised to promptly schedule a follow-up visit with his primary care physician. Patients with anal abscesses are at greatest risk of developing which of the following conditions?

Question

A 50-year-old male comes in to the emergency department complaining of unremitting pain in an area of his right buttock near the anus.  Although he is uncertain when the discomfort first began, he notes that the pain has increased significantly over the past 24 hours.  He finds he is unable to pass stool because of the pain.  He has not experienced symptoms like this before.  Ten years ago, he was diagnosed with diabetes mellitus.  He is currently on insulin.  He smokes half a pack of cigarettes per day but would like to quit.  He denies drinking alcohol or using recreational drugs.  His temperature is 38.1C (100.6F), blood pressure is 128/86 mm Hg, and pulse is 90/min.  There is a hot, tender, mass located between the anus and the left ischial tuberosity.  The mass fluctuates upon palpation.
The patient is treated appropriately.  To minimize risk of complications, he is advised to promptly schedule a follow-up visit with his primary care physician.  Patients with anal abscesses are at greatest risk of developing which of the following conditions?

Quizplus · Accepted Answer

Explanation: While an anal abscess is an infection within one or more of the anal spaces, an anal fistula (Choice B) is a tunneling between the anus or rectum and another epithelial lined space (eg, the skin overlying the drainage site). Fifty percent of patients with anal abscesses will go on to develop a chronic fistula from the involved anal gland to the overlying skin. Patients with fistulas typically present with an anal abscess that persists after incision and drainage, or with a pustule-like lesion in the perianal or ischiorectal area that continually drains. Surgical repair is usually necessary to eliminate the fistula while preserving fecal continence. Soft tissue infection (Choice A) is rarely a concern when the initial mass has been properly incised and drained. Fecal impaction (Choice C) could be of concern in a patient with an anal abscess who had been unable to pass stool for a long period before presenting for treatment. It does not commonly occur subsequent to treatment of anal abscess, however. Incontinence (Choice D) and hemorrhoids (Choice E) are not commonly associated with anal abscesses. Educational Objective: Fifty percent of patients with anal abscesses will go on to develop a chronic fistula from the involved anal gland to the overlying skin. Such fistulas require surgical repair.

A 50-Year-Old Male Comes in to the Emergency Department Complaining