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Perianal Crohn's Abscess — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyPerianal Crohn's AbscessRACP Adult Medicine

A 40-year-old taking infliximab for Crohn disease develops a fluctuant painful perianal abscess with a likely fistula. What is the immediate management priority?

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Correct answer: C — Arrange examination and urgent surgical drainage, with seton placement when a fistula is identified

The best answer is “Arrange examination and urgent surgical drainage, with seton placement when a fistula is identified”. A perianal abscess requires source control; examination under anaesthesia permits drainage and identification of a fistula, often managed initially with a non-cutting seton to protect continence. Antibiotics and biologic optimisation are adjuncts after sepsis control. Escalating immunosuppression into an undrained abscess and indiscriminate sphincter division are unsafe.

Reference: Gastroenterological Society of Australia: Clinical practice resources for inflammatory bowel disease: https://gesa.org.au/Web/Resources/Clinical_Practice_Resources.aspx