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Perianal abscess — MCCQE Part 1 MCQ

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ModerateAnorectal PainPerianal abscessMCCQE Part 1

A 45-year-old man has severe constant perianal pain and fever. Examination shows a fluctuant tender swelling lateral to the anus. Which of the following is the most appropriate management?

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Correct answer: D — Incision and drainage

A fluctuant perianal abscess requires incision and drainage because antibiotics alone penetrate poorly and do not evacuate pus. Antibiotics are added for systemic illness, immunocompromise or extensive cellulitis. Haemorrhoid treatment and fibre do not address an abscess.

Reference: Canadian colorectal surgery practice; acute anorectal pathways