Can an anorectal abscess be treated without surgery?

Name: Can an anorectal abscess be treated without surgery?
Published: 2026-10-05

In adults presenting with an anorectal (perianal) abscess, does treatment with antibiotics alone, compared with surgical incision and drainage, achieve comparable rates of abscess resolution, recurrence, and subsequent fistula formation?

Compiled 2026-10-05 · checked 2026-10-05 · next 2026-11-05 · automated review, how it works

Bottom line

No — for most adults, antibiotics alone are not a proven substitute for having the abscess drained.

The one randomised trial that tested this directly in adults found the abscess came back about three times more often when treated with a needle draw-off plus antibiotics than when it was cut open and drained. Other adult studies disagree with each other, which is why this is rated low certainty rather than settled.

How certain

Low

One well-conducted randomised trial addresses this question directly. The studies disagree with one another, so the overall certainty is lower than any single one of them.

What it shows

Signal of harm

A well-conducted study in people reported harm.

studies found: 72studies found
randomised trials: 2randomised trials
people studied: 11,312people studied
reviews of trials: 4reviews of trials
years covered: 2008–2026years covered

Read this first

Case reports describe adults whose abscess got worse on antibiotics alone, with spreading infection that then required urgent surgery.
Choosing antibiotics instead of drainage may mean the abscess simply comes back, meaning another doctor visit and another procedure later.

What the research shows

Resolution of the abscess without a repeat procedure
In the one trial that tested this directly, treating the abscess with antibiotics and a needle draw-off (instead of cutting it open) led to the abscess coming back far more often — 41% versus 15%.[1]
No improvement shown
Need for a later surgical drainage
People who started with antibiotics instead of a full cut-and-drain procedure were more likely to need a procedure later anyway.[1]
Possible harm
Recurrence of the abscess
The randomised trial found more recurrences with antibiotics-based treatment. A small study of adults on dialysis found no clear difference between the two approaches, but it was too small and not a trial, so it can't overturn the trial's finding.[1,2]
Possible harm
Time to pain and fever going away
No study in adults measured how fast symptoms cleared with antibiotics alone versus surgical drainage.
Not studied
Pain scores
No adult study reported pain scores comparing antibiotics alone against draining the abscess.
Not studied

What it may help with

In the one trial, draining the abscess with a needle plus a week of antibiotics did work for some adults and let them skip a bigger cutting procedure — it just failed noticeably more often than standard surgery.[1]

Important limitations

The only randomised trial on this question in adults had just 98 people — a small group for measuring something like recurrence of an infection.[1]
Most other adult evidence is retrospective (looking back at medical records, not a planned trial) and comes from specific, unusual groups — people on dialysis, people with leukemia, people with Crohn's disease — whose abscesses may not behave like a typical abscess in an otherwise healthy adult.[1,2,3]
A large share of the research on skipping surgery for an abscess was done in infants and young children, whose bodies and abscesses heal differently than adults'. Those findings cannot be assumed to carry over to grown adults.[1,2,3,4]

What the studies found

Found a benefit16 · 22%
Found no clear effect9 · 13%
Mixed or unclear42 · 58%
Found possible harm5 · 7%

What kind of studies

Case series27 · 38%
Retrospective20 · 28%
Narrative review12 · 17%
Guideline3 · 4%
Systematic review3 · 4%
Randomised trial2 · 3%
Prospective cohort2 · 3%
Meta-analysis1 · 1%
Registry1 · 1%
Animal study1 · 1%

The studies that decided it

Sørensen et al. 2021
Needle aspiration treatment vs. incision of acute simple perianal abscess: randomized controlled study
Needle draining failed more often than surgery.Randomised trialModerate quality
98 people52 weeks
abscess recurred much more often after needle aspiration (41%) than after incision drainage (15%)
Who was studied
adults with an acute simple perianal (anorectal) abscess
What they received
needle aspiration of the abscess plus a week of antibiotics (clindamycin)
Compared with
conventional surgical incision and drainage
Main outcome
whether the abscess came back (recurrence)
Quality
it was a randomized trial across three centers, but had under 100 patients and only one scheduled follow-up timepoint set per abscess type
Limitations
abstract does not report blinding; relatively small sample size
Taken word for word from the abstract
- population adults with acute perianal abscess
- intervention needle aspiration and postoperative antibiotics
- comparator conventional surgical incision drainage
- primaryOutcome The primary outcome was abscess recurrence.
- result The recurrence rate was 41% in needle aspiration and 15% in incision drainage, with HR of 3.033 (p = 0.014).
- n A total of 98 patients were included.
- followUp follow-up at 2, 12, and 52 weeks postoperatively
Int J Colorectal Dis · PMID 33447866 · Read it on PubMed ↗
Stokes et al. 2020
Management of perianal abscesses in infants without general anaesthesia: a systematic review of the literature
Most infants healed without surgery.Systematic reviewLow qualityRelated question
1,049 people2020
75.3% healed completely without further treatment; 23.2% had recurrence or progressed to a fistula; only 5.6% eventually needed general anaesthesia
Who was studied
infants younger than 24 months with perianal abscesses
What they received
treatment of the abscess without general anaesthesia (antibiotics, baths, needle drainage, local anaesthesia drainage, etc.)
Compared with
later need for drainage under general anaesthesia
Main outcome
number of infants who ended up needing general anaesthesia after being treated without it first
Quality
The evidence comes mostly from retrospective case series with no randomized trials, so the findings are not very reliable.
Limitations
No randomized controlled trials; mostly retrospective cohort studies with varied treatments and lack of standardized care.
Taken word for word from the abstract
- population infants less than 24 months old
- intervention management of perianal abscesses without GA in infants less than 24 months old
- comparator The primary outcome was the number of patients requiring GA following initial management without GA.
- primaryOutcome The primary outcome was the number of patients requiring GA following initial management without GA.
- result A total of 790 (75.3%) healed primarily without further intervention. A total of 243 (23.2%) were documented to have a recurrence or progression to FIA.
- result Of these, 59 (5.6%) were documented to subsequently require a general anaesthetic.
- n Nine studies, involving 1049 infants less than 24 months old met inclusion criteria.
- limitations There were no randomized control trials.
- quality Despite the lack of well-designed prospective studies, existing evidence supports management of perianal abscesses without initial GA in infants
Pediatr Surg Int · PMID 32785778 · Read it on PubMed ↗
Hsieh et al. 2019
Epidemiology and outcomes of anal abscess in patients on chronic dialysis: a 14-year retrospective study
Found no benefitRetrospectiveLow qualityRelated question
43 peopleone-year
no significant difference in hospital stay, one-year survival, or recurrence between surgical and nonsurgical groups, but a trend toward better in-hospital survival with surgery
Who was studied
chronic dialysis patients hospitalized for a first-time anal abscess
What they received
antibiotic treatment alone (no surgery)
Compared with
surgical treatment for the abscess
Main outcome
in-hospital death, one-year death, and one-year recurrence
Quality
small retrospective study with only 43 patients, not randomized, so differences between groups could explain the results rather than the treatment itself
Limitations
retrospective chart review, small sample size, specific to chronic dialysis patients, and a non-significant trend favoring surgery (p=0.082) that could reflect chance
Taken word for word from the abstract
- n 43 chronic dialysis patients with first-time anal abscess were enrolled
- population chronic dialysis patients
- intervention 16 (37.2%) received antibiotic treatment alone
- comparator 27 (62.7%) received surgical treatment
- primaryOutcome The endpoints of this study were in-hospital mortality, one-year mortality and one-year recurrence.
- result there was no significant difference in hospital stay, one-year survival or recurrence rate between the surgical group and nonsurgical group. However, there was a trend toward better in-hospital survival in patients who received surgical treatment (p=0.082).
Clinics (Sao Paulo) · PMID 30916172 · Read it on PubMed ↗
Wright 2016
Infectious Diseases Perspective of Anorectal Abscess and Fistula-in-ano Disease
Antibiotics alone don't replace surgery usually.Systematic reviewLow quality
size not given2016
antibiotics added to surgery did not speed healing or lower recurrence for common cases, but antibiotics alone worked well for rare pathogen infections
Who was studied
patients with anorectal abscess and fistula-in-ano, mostly from common gut bacteria but some from unusual infections
What they received
antibiotic therapy combined with surgical incision and drainage, or antibiotics alone for unusual infections
Compared with
surgical incision and drainage alone
Main outcome
healing time and recurrence rate
Quality
this is a review of mostly retrospective studies and case series rather than controlled trials, so the evidence is weak.
Limitations
Abstract states data are derived primarily from prospective and retrospective trials and institutional case series, providing only an 'evidence level opinion' rather than controlled comparisons.
Taken word for word from the abstract
- population Most patients are diagnosed with cryptoglandular disease but unusual infections raise difficult antimicrobial management challenges.
- intervention The use of antimicrobial therapy in combination with surgical incision and drainage in the treatment of cryptoglandular disease
- comparator Surgical incision and drainage is the main treatment for anorectal abscess and fistula-in-ano
- primaryOutcome has failed to improved healing times or reduce recurrences or both
- result The use of antimicrobial therapy in combination with surgical incision and drainage in the treatment of cryptoglandular disease has failed to improved healing times or reduce recurrences or both.
- result For patients with unusual infecting pathogens (eg, Mycobacterium tuberculosis, Actinomyces species and Chlamydia species) outcomes are favorable with selected antimicrobial therapy agents of various durations.
- limitations data derived primarily from prospective and retrospective trials as well as institutional case series to provide an evidence level opinion
Am J Med Sci · PMID 27079352 · Read it on PubMed ↗
Chen et al. 2013
Clinical and microbiological characteristics of perianal infections in adult patients with acute leukemia
Surgery trend fewer recurrences, not significantRetrospectiveLow qualityRelated question
74 people2013
patients who had surgery tended to have fewer recurrences, but this was not statistically significant
Who was studied
adult patients with acute leukemia who developed perianal infection
What they received
surgical treatment of the perianal infection/anal fistula
Compared with
non-surgical (medical) management of the perianal infection
Main outcome
recurrence of perianal infection
Quality
this is a single-center retrospective review with a small subgroup comparison that just missed statistical significance, so it can't reliably show whether surgery helps.
Limitations
retrospective design, single center, surgical vs non-surgical comparison was not significant (p=0.067), and patients are immunocompromised leukemia patients rather than the general population with anorectal abscess
Taken word for word from the abstract
- n Twenty-five (34%) of 74 patients received surgical intervention.
- population The prevalence of perianal infection was 6.7% (74 of 1102) in adult patients with acute leukemia.
- intervention Acute leukemia patients with surgically managed anal fistulas tended to have fewer recurrences (p = 0.067).
- comparator neutropenia and bleeding tendency are relatively contraindicated to surgical intervention
- primaryOutcome Twenty-three (31%) of the 74 patients had recurrent episodes of perianal infections.
- result Acute leukemia patients with surgically managed anal fistulas tended to have fewer recurrences (p = 0.067).
PLoS One · PMID 23577135 · Read it on PubMed ↗
Afşarlar et al. 2011
Perianal abscess and fistula-in-ano in children: clinical characteristic, management and outcome
No difference: surgery vs. no surgery.RetrospectiveLow quality
158 people10.6 ± 8.6 months
no significant difference in recurrence or fistula formation between incision/drainage and spontaneous drainage groups, but antibiotics reduced fistula formation
Who was studied
children with perianal abscess and fistula-in-ano, median age 7.2 months
What they received
incision and drainage of the abscess, with or without antibiotics
Compared with
spontaneous drainage with local wound care, with or without antibiotics
Main outcome
recurrence of abscess and development of fistula-in-ano
Quality
This was a retrospective chart review without randomization, so differences between treatment groups could be due to other factors rather than the treatment itself.
Limitations
Retrospective design, not randomized, and follow-up period was relatively short and variable (mean 10.6 ± 8.6 months).
Taken word for word from the abstract
- n A total of 158 children (146 males, 12 females) treated for perianal abscess and fistula-in-ano with a median age of 7.2 months (ranging 16 days to 18 years) were eligible for the study.
- population A total of 158 children (146 males, 12 females) treated for perianal abscess and fistula-in-ano with a median age of 7.2 months (ranging 16 days to 18 years) were eligible for the study.
- intervention Primary treatment was incision and drainage (I/D) for the fluctuating perianal abscess (73.5%)
- comparator and local care for the spontaneously (S/D) drained abscess (26.5%) with or without antibiotic therapy.
- primaryOutcome Recurrence rates (27% in I/D and 30.6% in S/D, p > 0.05) and development of fistula-in-ano (20% in I/D and 27.8 in S/D, p > 0.05) were not significant I/D and S/D groups.
- result Recurrence rates (27% in I/D and 30.6% in S/D, p > 0.05) and development of fistula-in-ano (20% in I/D and 27.8 in S/D, p > 0.05) were not significant I/D and S/D groups.
- followUp The mean follow-up period was 10.6 ± 8.6 months.
Pediatr Surg Int · PMID 21785979 · Read it on PubMed ↗
Ezer et al. 2010
Perianal abscess and fistula-in-ano in children: aetiology, management and outcome
High fistula rate despite treatment.Case seriesLow quality
39 people2010
85% of abscess patients went on to develop a fistula regardless of initial treatment, only 15% healed without fistula
Who was studied
children with perianal abscess and/or fistula-in-ano
What they received
incision and drainage with antibiotics, or antibiotics alone (non-surgical) for perianal abscess
Compared with
surgical treatment (fistulotomy or fistulectomy) for the resulting fistula
Main outcome
development of fistula-in-ano after treatment of perianal abscess
Quality
small retrospective case series without a control group, so it can't reliably show whether avoiding surgery works.
Limitations
retrospective design, no comparison group, some patients lost to follow-up
Taken word for word from the abstract
- n The study consisted of 39 patients (36 boys)
- population perianal abscess and/or fistula-in-ano in children
- intervention local care with antibiotic therapy was given to four patients
- intervention The primary local treatment of perianal abscess with or without fistula was incision and drainage (with or without antibiotic therapy) in 21 patients
- comparator Thirty-three patients with fistula-in-ano underwent surgical treatment either through a fistulotomy or through a fistulectomy.
- primaryOutcome Of 20 patients with perianal abscess, 17 developed fistula-in-ano and three healed.
- result Treatment of a perianal abscess either through incision and drainage with antibiotics or through antibiotics alone resulted in a high rate (85%) of fistula formation.
J Paediatr Child Health · PMID 20105258 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

All 72 studiesEvery study that answered the question, with its design, size and result.

The other 65 studiesEverything else the search returned, including anything retracted.

Yuan et al. 2026
Age-stratified management of pediatric perianal abscesses: a proposed framework integrating the "Developmental Healing Axis"
Non-surgical care often works in young children.Narrative reviewVery low qualityRelated question
size not given2026
conservative management often works well in infants and young children, while surgery may raise fistula risk especially in older children
Who was studied
children with perianal abscesses
What they received
conservative treatment with antibiotics and observation
Compared with
surgical incision and drainage
Main outcome
healing, recurrence, and fistula formation
Quality
This is a narrative review summarizing other studies and opinions rather than presenting new controlled data.
Limitations
The abstract does not report specific study designs, patient numbers, or statistical results; it is a conceptual synthesis rather than original research.
Taken word for word from the abstract
- population Pediatric perianal abscesses represent a frequent yet underrecognized condition
- intervention conservative strategies including antibiotic therapy and observation are often effective in infants and young children
- comparator Surgical interventions such as incision and drainage offer rapid symptom relief but may increase the risk of fistula formation, particularly in older children
- primaryOutcome optimize recovery, minimize recurrence, and prevent fistula development
- result conservative strategies including antibiotic therapy and observation are often effective in infants and young children, reflecting their superior regenerative capacity
Front Pediatr · PMID 42221001 · Read it on PubMed ↗
Eldesouki et al. 2026
Comparison of Ustekinumab and Vedolizumab Effectiveness in Perianal Crohn's Disease: A Retrospective Propensity Matched Cohort Study
No difference in abscess drainage ratesRetrospectiveLow qualityRelated question
1,872 people1 and 2 years
ustekinumab had lower rates of fistula surgery and combined surgical events than vedolizumab, but incision and drainage of abscess and diversion procedure rates were not significantly different between the two drugs
Who was studied
adults with perianal Crohn's disease
What they received
ustekinumab (a biologic drug)
Compared with
vedolizumab (a biologic drug)
Main outcome
need for perianal procedures such as fistula surgery, abscess incision and drainage, diversion surgery, or antibiotics
Quality
This is a retrospective database study comparing two drugs, not a trial testing surgery versus no surgery for abscess, so it can carry little weight on this specific question.
Limitations
Retrospective design using a health records database, propensity matching cannot remove all confounding, and the study compares two biologic drugs rather than directly testing whether abscess can avoid surgery.
Taken word for word from the abstract
- population adults (18 y or older) with PCD
- intervention ustekinumab (UST)
- comparator vedolizumab (VDZ)
- primaryOutcome Outcomes were perianal-specific clinical events, including definitive fistula surgery, incision and drainage, diversion procedures, and antibiotic use (metronidazole or ciprofloxacin), assessed at 1 and 2 years after biological initiation.
- result UST was associated with significantly lower risk of definitive perianal fistula surgery (HR: 0.66, 95% CI: 0.50-0.89; P<0.01), and composite surgical events (HR: 0.70, 95% CI: 0.54-0.87; P<0.01) compared with VDZ at 1 year. Rates of antibiotic use, incision and drainage of perianal abscess, and diversion procedures were numerically lower but not statistically significant.
- n After PSM, 936 patients were included in each cohort.
- followUp assessed at 1 and 2 years after biological initiation
J Clin Gastroenterol · PMID 42213056 · Read it on PubMed ↗
Sagar et al. 2026
Diagnostic insight into recurrent perianal abscess caused by Cutibacterium avidum: A case report
Recovered after drainage plus targeted antibiotics.Case seriesVery low qualityRelated question
1 people2026
after targeted antibiotic treatment following surgical drainage, the patient recovered fully with no further abscesses
Who was studied
53-year-old man with repeated perianal abscesses
What they received
targeted antibiotics after surgical drainage, guided by identifying the bacteria
Compared with
previous repeated incision, drainage, and empiric antibiotics that didn't work
Main outcome
recovery without recurrence of abscess
Quality
this is a single patient case report, so it cannot show whether avoiding surgery works in general and it actually involved surgical drainage plus antibiotics, not antibiotics alone.
Limitations
single case report; surgical drainage was still performed alongside targeted antibiotics, so it does not test treatment without surgery
Taken word for word from the abstract
- n a 53-year-old male with recurrent perianal abscesses
- population a 53-year-old male with recurrent perianal abscesses unresponsive to repeated incision, drainage, and empiric antibiotics
- intervention Targeted therapy following surgical drainage resulted in uneventful recovery and no recurrence
- comparator recurrent perianal abscesses unresponsive to repeated incision, drainage, and empiric antibiotics
- primaryOutcome resulted in uneventful recovery and no recurrence
- result Targeted therapy following surgical drainage resulted in uneventful recovery and no recurrence.
Indian J Med Microbiol · PMID 42191117 · Read it on PubMed ↗
Dermuth et al. 2026
Scrotal abscesses in perianal Crohn's disease: a retrospective cohort study of clinical presentation, management, and outcomes
Describes outcomes, not surgery-avoidance.RetrospectiveLow qualityRelated question
40 people12 months
All patients got antibiotics, with some having bedside drainage and others operative drainage; 40% had recurrence within a year, 20% needed treatment escalation, 35% required fecal diversion, and 20% underwent proctectomy
Who was studied
men with Crohn's disease who developed abscesses in the scrotum
What they received
antibiotics with or without bedside or operative drainage of the abscess
Compared with
different drainage approaches (bedside incision and drainage versus operative drainage) within the same group
Main outcome
recurrence, need for escalation of therapy, fecal diversion, or proctectomy after treatment
Quality
This is a retrospective, descriptive study of a rare complication without a control group comparing surgery to no surgery, so it can't show whether avoiding surgery works.
Limitations
Retrospective design, no comparison group, and focuses specifically on scrotal abscesses rather than anorectal abscesses in general.
Taken word for word from the abstract
- population retrospective cohort study of male patients with Crohn's who developed scrotal abscesses
- n A total of 40 patients were identified.
- intervention All patients received antibiotics; 30% underwent bedside incision and drainage, and 37.5% underwent operative drainage.
- comparator 30% underwent bedside incision and drainage, and 37.5% underwent operative drainage
- primaryOutcome recurrence within 12 months occurred in 40%, and escalation of advanced therapy in 20%
- result Hospital admission was required in 60%, recurrence within 12 months occurred in 40%, and escalation of advanced therapy in 20%. During follow-up, 35% required fecal diversion (72% or 25% overall), and 20% underwent proctectomy.
- followUp recurrence within 12 months occurred in 40%
Tech Coloproctol · PMID 42120818 · Read it on PubMed ↗
Gadepalli et al. 2026
Antibiotic Utilization for Perianal Fistulizing Complications among Young Patients with Crohn's Disease
More antibiotics used, no surgery data.RetrospectiveLow qualityRelated question
5,277 people2026
Patients with perianal fistulizing complications received significantly more days of antibiotics than those without, with 90% more dispensing after adjustment
Who was studied
Children and young adults with Crohn's disease, some with perianal fistulizing complications
What they received
Antibiotic prescriptions/dispensing patterns
Compared with
Patients with Crohn's disease but without perianal fistulizing complications
Main outcome
Number of days of antibiotics dispensed
Quality
This is a retrospective claims-database study describing antibiotic use patterns, not a trial testing whether antibiotics can avoid surgery for abscess.
Limitations
Retrospective administrative claims data; studies Crohn's disease-related perianal fistulizing complications in children, not simple anorectal abscess in a general population; no data on surgical avoidance or abscess resolution outcomes.
Taken word for word from the abstract
- n Five thousand two hundred seventy-seven patients were included
- population children with Crohn's disease and perianal fistulizing complications (PFCs)
- intervention Antibiotic dispensing was common, 83% had at least 1 antibiotic prescription.
- comparator Patients with PFC had more antibiotic days (median 67 days, IQR 26-138) compared with those without PFC (median 27 days, IQR 10-63; P = .001).
- primaryOutcome Multivariable negative binomial regression evaluated predictors of days of antibiotics dispensed.
- result In an adjusted model, patients with PFC had 90% more antibiotic dispensing than those without PFC.
J Pediatr · PMID 42105935 · Read it on PubMed ↗
Kristjansdottir et al. 2026
[Perianal tuberculosis]
TB-caused abscess healed after surgery plus TB drugs.Case seriesVery low qualityRelated question
1 people2026
the perianal wound healed well following anti-tuberculosis treatment after initially healing poorly post-surgery
Who was studied
a healthy 41-year-old man diagnosed with a perianal abscess
What they received
surgical drainage followed by a six-month course of anti-tuberculosis medications
Compared with
none reported (single case report)
Main outcome
healing of the perianal wound
Quality
This is a single patient case report, so it cannot show whether abscesses in general can be treated without surgery.
Limitations
Only one patient described; the abscess was surgically drained before the underlying tuberculosis was found and treated, so it does not test avoiding surgery.
Taken word for word from the abstract
- n a healthy 41-year-old man diagnosed with a perianal abscess
- population a healthy 41-year-old man diagnosed with a perianal abscess
- intervention required examination and surgical drainage under general anesthesia
- intervention The patient received a six-month course of anti-tuberculosis medications
- comparator This report describes a healthy 41-year-old man diagnosed with a perianal abscess
- primaryOutcome The wound healed poorly over the following months
- result The perianal wound healed well following treatment
Laeknabladid · PMID 41733318 · Read it on PubMed ↗
Cohen-Mekelburg et al. 2026
AGA Clinical Practice Update on Inpatient Management of Adults With Inflammatory Bowel Disease: Expert Review
Guideline, not surgery-avoidance evidence.GuidelineVery low qualityRelated question
size not given2026
guideline advises that intra-abdominal abscesses in Crohn's disease be treated with drainage and antibiotics, with further medical or surgical management decided individually, but does not report whether anorectal abscess can be treated without surgery
Who was studied
hospitalized adult patients with inflammatory bowel disease (IBD)
What they received
abscess drainage and systemic antibiotics, with medical or surgical management decided case by case
Quality
This is an expert consensus guideline without a systematic review of evidence or original patient data, so it cannot establish whether surgery can be avoided.
Limitations
Not a systematic review; based on expert opinion; focuses on intra-abdominal abscess and perianal symptoms in IBD patients generally, not specifically anorectal abscess treated without surgery.
Taken word for word from the abstract
- population hospitalized adult patients with IBD
- intervention treatment should include infection control with abscess drainage (depending on size and location) and systemic antibiotics, as well as decision making regarding further medical or surgical management
- result In hospitalized adult patients with Crohn's disease and an intra-abdominal abscess, treatment should include infection control with abscess drainage (depending on size and location) and systemic antibiotics, as well as decision making regarding further medical or surgical management.
- result Hospitalized adult patients with Crohn's disease and active perianal symptoms should have a multidisciplinary treatment approach involving both medical and surgical care.
- qualityWhy Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings of the quality of evidence or strength of the presented considerations.
Gastroenterology · PMID 41579011 · Read it on PubMed ↗
Mersal et al. 2026
Beyond the Knife: A Contemporary Review of Subcutaneous Abscesses
Surgery still needed; antibiotics help, packing doesn't.Narrative reviewLow qualityRelated question
size not given2026
Adding antibiotics after drainage improved short-term cure and reduced new lesions for ordinary skin abscesses; for perianal abscesses, trial results conflicted though pooled data hinted at a modest benefit from antibiotics in preventing fistula; packing the wound gave no benefit and increased pain
Who was studied
patients with subcutaneous and perianal (anorectal) abscesses
What they received
post-drainage care strategies such as antibiotics, wound packing, drains, irrigation, or primary closure after incision and drainage
Compared with
incision and drainage alone or with packing versus without packing
Main outcome
cure rates, recurrence, fistula formation, and pain after treatment
Quality
This is a narrative summary of other studies without a described systematic search or pooled statistical analysis, so its conclusions carry less certainty.
Limitations
The abstract does not describe its own search methodology, does not separate results clearly by abscess type for all claims, and treats incision and drainage as the assumed first step rather than testing whether surgery can be avoided.
Taken word for word from the abstract
- population Subcutaneous abscesses are among the most common soft-tissue infections encountered in acute surgical and emergency practice
- population particularly relevant to perianal abscesses
- intervention whether adjunct antibiotics improve cure rates or prevent recurrence, whether packing the cavity provides any advantage, and whether modern alternatives such as primary closure, drains, or irrigation offer superior outcomes
- comparator Perhaps the clearest evidence-based shift is against routine packing
- primaryOutcome whether adjunct antibiotics improve cure rates or prevent recurrence
- primaryOutcome the risk of developing a fistula-in-ano is substantial
- result adding a short course of MRSA-active antibiotics to I&D improves short-term cure and reduces new lesions
- result the trials conflict, pooled estimates hint at a modest benefit from antibiotics
- result routine packing, as it offers no outcome advantage and clearly increases pain
ANZ J Surg · PMID 41420370 · Read it on PubMed ↗
Alam et al. 2025
Does antibiotic therapy for anal abscess reduce the risk of fistula surgery? A retrospective study
Antibiotics after drainage may lower recurrence.RetrospectiveLow qualityRelated question
109 peopleapproximately 30 months
absence of antibiotic therapy after incision was linked to higher recurrence (univariate OR 0.44 for antibiotics), but this was not confirmed in multivariate analysis due to insufficient data
Who was studied
adults with a first-time perianal (anal) abscess treated by incision under local anesthesia
What they received
antibiotic therapy given after incision of the abscess
Compared with
no antibiotic therapy after incision
Main outcome
rate of patients needing fistula surgery and/or abscess recurrence
Quality
This was a small retrospective study with only univariate analysis (no multivariate confirmation), so the antibiotic effect is uncertain.
Limitations
Retrospective design, no multivariate analysis possible due to insufficient data, and all patients still underwent incision rather than avoiding surgery entirely.
Taken word for word from the abstract
- population all patients presenting in 2019 with a first perianal abscess treated by incision under local anesthesia, with or without antibiotic therapy post-incision
- intervention post-incision antibiotic therapy
- comparator absence of antibiotic therapy post-incision
- primaryOutcome The primary outcome was the rate of patients requiring fistula surgery and/or experiencing abscess recurrence
- result Univariate logistic regression analysis revealed smoking and absence of antibiotic therapy post-incision as predictive of recurrence with (OR 0.44) were predictive of recurrence.
- result Multivariate analysis was not conducted due to insufficient data.
- n 109 were included
- followUp The mean follow-up for patients with incision alone was approximately 30 months
Clin Res Hepatol Gastroenterol · PMID 41047078 · Read it on PubMed ↗
Salimi et al. 2025
Comparative Approaches of Antibiotic Therapy and Surgical Intervention in Managing Recurrent Perirectal Abscess in Children Under Two Years Old
Antibiotics alone had fewer recurrences.RetrospectiveLow quality
336 people2025
Antibiotic-only group had the lowest recurrence rate and symptoms resolved in 3-10 days (average 6 days), while spontaneous drainage had a 37% recurrence rate
Who was studied
Children under two years old with perianal (perirectal) abscesses
What they received
Antibiotic therapy alone
Compared with
Spontaneous drainage or surgical incision and drainage
Main outcome
Recurrence of the abscess and time to symptom resolution
Quality
This was a retrospective, non-randomized study where group differences (like abscess size and location) could bias the results.
Limitations
Retrospective design without randomization; groups differed in abscess size and location, which could affect outcomes.
Taken word for word from the abstract
- n This retrospective cohort study analyzed 336 medical records of children under two years old with perianal abscesses
- population children under two years old with perianal abscesses
- intervention antibiotic treatment only
- comparator spontaneous drainage, and incision and drainage
- primaryOutcome treatment outcomes (recurrence, fistula formation)
- result The spontaneous drainage group had a significantly higher recurrence rate (37%). Antibiotic type distribution was similar across groups. The antibiotic-only group showed symptom resolution within 3-10 days, averaging 6 days.
Middle East J Dig Dis · PMID 40994801 · Read it on PubMed ↗
Acker et al. 2025
Management of Perianal Abscesses in Infants: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee
Similar outcomes with or without surgerySystematic reviewLow qualityRelated question
size not given2025
About 37.5% of non-surgical treatment failed initially, and recurrence/fistula rates were similar whether treated with non-surgical care or incision and drainage
Who was studied
infants with perianal abscess or fistula-in-ano
What they received
non-operative management (hygiene, sitz baths, systemic antibiotics)
Compared with
surgical drainage (incision and drainage) or direct fistula surgery
Main outcome
failure, recurrence, and fistula formation rates after treatment
Quality
The review is based only on lower-quality (level 3-4) studies with no randomized trials, so the comparisons are uncertain.
Limitations
Included only level 3-4 evidence, no randomized trials, and findings may not apply beyond the infant population studied
Taken word for word from the abstract
- population Management of infant perianal disease, including perianal abscess and fistula-in- ano (FIA)
- intervention nonoperative management (NOM) strategies (such as hygiene, sitz baths, and systemic antibiotics)
- comparator operative intervention for abscess only (incision and drainage (I&D)) or direct surgical management of the FIA (e.g. upfront fistulotomy)
- primaryOutcome Initial failure of NOM is approximately 37.5 %. Recurrence rate after initial success with NOM or I&D is approximately 21 % and 24 %, respectively.
- result Initial failure of NOM is approximately 37.5 %. Recurrence rate after initial success with NOM or I&D is approximately 21 % and 24 %, respectively. The rate of FIA development is approximately 21 % after NOM and 20 % after I&D.
- quality Systematic Review of level 3-4 studies. LEVEL OF EVIDENCE: Level 4.
J Pediatr Surg · PMID 40983150 · Read it on PubMed ↗
Callisperis et al. 2025
Necrotizing Fasciitis Treatment With Chlorine Dioxide: A Case Report in an Immunocompromised Patient
Survived abscess, but surgery still usedCase seriesVery low qualityRelated question
1 people2025
the patient survived after receiving surgical removal of infected tissue, antibiotics, chlorine dioxide, and intensive supportive care
Who was studied
a 48-year-old man with poorly controlled diabetes, liver cirrhosis, and kidney disease who developed a perianal abscess that progressed to severe tissue infection (Fournier's gangrene)
What they received
chlorine dioxide treatment added to standard care
Compared with
no separate comparison group; outcome described before and after treatment
Main outcome
patient survival and recovery from severe infection
Quality
this is a single patient case report, so it cannot show whether treatment works in general or whether surgery can be avoided.
Limitations
single case, surgery was still performed alongside the experimental treatment, no comparison group, cannot isolate effect of chlorine dioxide
Taken word for word from the abstract
- population a 48-year-old male with multiple comorbidities, including decompensated liver cirrhosis, poorly controlled diabetes mellitus, and chronic kidney disease, who developed a perianal abscess complicated by Fournier's gangrene
- intervention innovative treatment with chlorine dioxide
- comparator surgical debridement, targeted antimicrobial therapy, innovative treatment with chlorine dioxide, and intensive supportive care
- primaryOutcome the patient survived
- result the patient survived following surgical debridement, targeted antimicrobial therapy, innovative treatment with chlorine dioxide, and intensive supportive care
- n a 48-year-old male
Cureus · PMID 40861634 · Read it on PubMed ↗
Rodríguez-Lago et al. 2025
Spanish Working Group in Crohn's Disease and Ulcerative Colitis (GETECCU) position paper for the management of non-perianal fistulizing Crohn's disease
Not directly studied here.GuidelineLow qualityRelated question
size not given2025
the abstract does not evaluate anorectal abscess treatment; it discusses non-perianal fistulas and states that drainage or surgery remains essential in certain severe or treatment-resistant cases
Who was studied
people with Crohn's disease who develop fistulas not in the anal area
What they received
medical and interventional treatments (supportive care, antibiotics, biologic drugs)
Compared with
percutaneous drainage or surgery
Main outcome
best way to manage non-perianal fistulas in Crohn's disease
Quality
This is an expert position paper about a different condition (non-perianal fistulas), not a study testing non-surgical treatment of anorectal abscess.
Limitations
Abstract explicitly states evidence in this area is limited and guidelines lack specific recommendations; it does not address anorectal (perianal) abscess specifically.
Taken word for word from the abstract
- population Fistulas that do not involve the perianal region (entero-enteric, entero-urinary, or entero-cutaneous)
- intervention general supportive measures to the use of antibiotics or, frequently, advanced therapies
- comparator percutaneous drainage or surgical intervention remains essential
- primaryOutcome provide a comprehensive overview of non-perianal fistulizing Crohn's disease, addressing its epidemiological, clinical, and therapeutic aspects
- result in cases of certain septic complications or those refractory to medical treatment, percutaneous drainage or surgical intervention remains essential
Gastroenterol Hepatol · PMID 40250758 · Read it on PubMed ↗
Wang et al. 2025
Comparing surgical and conservative treatment approaches for perianal abscess in patients with hematologic malignancies: a comprehensive analysis
Similar healing, surgery had fewer recurrences.RetrospectiveLow qualityRelated question
53 people60-day follow-up period
no significant difference in cure rates between groups; recurrence rates also not statistically different, though surgery group had numerically lower recurrence; conservative group recovered faster
Who was studied
patients with hematologic malignancies who developed perianal abscess
What they received
conservative (non-surgical) drug treatment for perianal abscess
Compared with
surgical treatment for perianal abscess
Main outcome
symptom improvement/cure and recurrence within 60 days
Quality
This was a small retrospective study without randomization, so it cannot reliably separate true differences from chance or bias.
Limitations
Retrospective design, small sample size, specific to patients with hematologic malignancies rather than the general population.
Taken word for word from the abstract
- n In total, 53 patients were enrolled in this study, including 19 cases with surgical intervention, and 34 cases with conservative treatment.
- population Perianal abscess (PA) is a complication of infection in patients with hematologic malignancies.
- intervention 34 cases with conservative treatment
- comparator 19 cases with surgical intervention
- primaryOutcome a significant improvement of symptoms or complete resolution was observed in 48 patients (90.5%)
- result the cure rates between the two groups showed no significant difference (p > 0.05)
- result there was no statistically significant disparity in recurrence rates (10.4% vs. 23.6%, p > 0.05)
- result Patients with conservative treatment showed significantly shorter recovery time compared to patients with surgical treatment (p = 0.048).
- followUp During the 60-day follow-up period
BMC Gastroenterol · PMID 40217138 · Read it on PubMed ↗
Blondin et al. 2025
Antibiotic use during the first episode of acute perianal sepsis: a still-open question
Antibiotics linked to fewer fistulas.RetrospectiveLow qualityRelated question
276 people1 year
fistula formation occurred in 54.0% of patients who received antibiotics versus 75.0% of those who did not (P<0.001), remaining significant after propensity weighting (odds ratio 0.53)
Who was studied
patients having their first episode of acute perianal sepsis (abscess)
What they received
antibiotic therapy
Compared with
no antibiotic therapy
Main outcome
development of fistula in ano at 1 year
Quality
This is a retrospective study without randomization, so it can show a link but not prove antibiotics actually cause fewer fistulas.
Limitations
Retrospective design; authors state a causal relationship could not be established; no information on whether surgical drainage was performed instead of or alongside antibiotics.
Taken word for word from the abstract
- n This study included 276 patients.
- population patients experiencing their first episode of acute perianal sepsis
- intervention with and without antibiotic therapy
- comparator with and without antibiotic therapy
- primaryOutcome compared the incidence of fistula in ano in patients experiencing their first episode of acute perianal sepsis
- result fistula formation was identified in 65.6% of all patients, 54.0% of those who had received antibiotics, and 75.0% of those who had not (P<0.001)
Ann Coloproctol · PMID 39895142 · Read it on PubMed ↗
Palma García et al. 2026
Continuous endoscopic manual suturing for colorectal anastomotic fistula closure
Nonsurgical closure failed, needed surgery.Case seriesVery low qualityRelated question
size not givenone month of hospitalization
the opening reopened and the abscess did not fully resolve, so surgery was planned
Who was studied
a man with a fistula and abscess near the rectum after prior rectal cancer surgery
What they received
endoscopic manual suturing of the fistula opening after argon treatment
Compared with
earlier attempts with antibiotics and vacuum-assisted closure
Main outcome
closing the fistulous opening without surgery
Quality
it is a single patient case report, so it cannot show whether this approach generally works.
Limitations
single case, no comparison group, and the condition was a post-surgical anastomotic fistula rather than a typical anorectal abscess
Taken word for word from the abstract
- population underwent a low anterior resection in 2015 for rectal adenocarcinoma
- population perianal abscess in the left posterior gluteal region, with a palpable internal fistulous orifice 3 cm from the anal margin
- intervention we proceeded with continuous manual suturing after argon application
- comparator Vacuum-assisted closure was attempted but was unsuccessful due to technical difficulties and the small size of the cavity
- comparator Despite initial antibiotic therapy with amoxicillin/clavulanic and poor clinical response
- primaryOutcome achieving complete closure of the fistulous opening
- result A follow-up colonoscopy showed persistence of the fistulous orifice with suture material, although radiologically there was a clear decrease in the abscess
- result after one month of hospitalization with a stable fistula but no definitive resolution, a planned surgical intervention was decided
Rev Esp Enferm Dig · PMID 39784726 · Read it on PubMed ↗
Takakazu Ribas Asato et al. 2024
Intestinal Tuberculosis With Recurrent Gluteal Abscesses and Perianal Fistulas: A Case Report and Literature Review
Fistulas improved with TB drugs, not surgery.Case seriesVery low qualityRelated question
1 people2024
Fistulas progressively improved with antituberculous and antimicrobial treatment after repeated surgical treatments had failed to prevent recurrence
Who was studied
A 45-year-old man with chronic buttock abscess and perianal fistulas, later diagnosed with intestinal tuberculosis
What they received
Standard antituberculosis drugs (rifampin, isoniazid, pyrazinamide, ethambutol) plus antibiotics and antifungals, after prior surgical treatments had failed
Compared with
No comparator; single patient followed over time with prior surgical treatments that had failed
Main outcome
Improvement of fistulas and prevention of abscess recurrence
Quality
This is a single patient case report, so it cannot reliably show whether this approach works in general.
Limitations
Single case report; underlying cause was intestinal tuberculosis, not a typical anorectal abscess; no control group; outcome described only as 'progressive improvement' without detailed follow-up data.
Taken word for word from the abstract
- n A 45-year-old male patient presented with a chronic abscess in the left buttock lasting for two years
- population A 45-year-old male patient presented with a chronic abscess in the left buttock lasting for two years, characterized by spontaneous purulent drainage and multiple recurrences despite surgical and clinical treatments.
- intervention Treatment included a standard antituberculous regimen (rifampin, isoniazid, pyrazinamide, and ethambutol), along with antibiotics and antifungal agents for secondary infections.
- comparator multiple recurrences despite surgical and clinical treatments
- primaryOutcome Adherence to treatment was satisfactory, with progressive improvement in the fistulas.
- result Adherence to treatment was satisfactory, with progressive improvement in the fistulas.
Cureus · PMID 39734561 · Read it on PubMed ↗
Neville et al. 2025
Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two Centres in the United Kingdom
Non-surgery had more recurrence.RetrospectiveLow quality
116 people3 (IQR 2-6) months
Recurrence was significantly higher with non-operative management (53% vs 23%), and operative management was linked to lower recurrence risk; further surgery was also more common after non-operative treatment, though fistula rates were similar between groups
Who was studied
Infants aged 12 months or younger with perianal abscess
What they received
Non-operative treatment (antibiotics and/or aspiration under local anaesthetic)
Compared with
Operative treatment (incision and drainage under general anaesthesia)
Main outcome
Recurrence of perianal abscess and need for further surgery
Quality
This is a retrospective study without randomization, so differences between groups could be due to other factors rather than treatment choice.
Limitations
Retrospective design, management based on surgeon preference, short median follow-up of 3 months
Taken word for word from the abstract
- n 116 infants were identified
- population infants aged ≤12 months presenting with PA
- intervention non-operative treatments, such as antibiotics and/or aspiration under local anaesthetic
- comparator incision and drainage under general anaesthesia
- primaryOutcome Recurrence occurred in 49/116 (42 %)
- result Recurrence occurred in 49/116 (42 %) at a median time of 1 (IQR 0-3) month and was significantly higher in the non-operative compared to the operative group (39/73 [53 %] versus 10/43 [23 %], p = 0.001)
- followUp Median follow-up was 3 (IQR 2-6) months
J Pediatr Surg · PMID 39693822 · Read it on PubMed ↗
Wessendorf et al. 2024
Butyricimonas faecihominis: an atypically resistant bacterium implicated in abscess formation - a case report
Case report, surgery still needed.Case seriesVery low qualityRelated question
1 peoplesix months later
Patient improved after switching to meropenem and underwent surgery, discharged after 40 days
Who was studied
50-year-old man with perianal abscess, history of cocaine abuse and bilateral hip replacements
What they received
antibiotics (meropenem) plus surgery including protective transversostomy
Quality
This is a single patient case report, so it cannot show whether surgery can be avoided.
Limitations
Single case report; patient required surgery (transversostomy) in addition to antibiotics, so it does not test non-surgical treatment alone; no comparison group.
Taken word for word from the abstract
- population a perianal abscess in a 50-year-old man with a history of cocaine abuse and bilateral hip replacements
- intervention The immediate switch to meropenem led to a significant improvement in the patient's condition
- intervention requiring intensive care unit admission, surgery including protective transversostomy
- result The patient was discharged after 40 days of hospitalization in good general condition and the reversal of the transversostomy was performed six months later.
- n We present the case of a perianal abscess in a 50-year-old man
BMC Infect Dis · PMID 39004725 · Read it on PubMed ↗
Singh et al. 2023
Clinical and magnetic resonance imaging spectrum of complex perianal fistulizing Crohn's disease: A cohort study from northern India
Mostly medical therapy, not surgery.RetrospectiveVery low qualityRelated question
27 people2023
Most patients were managed with medical therapy alone; only about one in five also had surgery, and abscess outcomes after treatment were not reported separately
Who was studied
adults with Crohn's disease who had complex perianal fistulas
What they received
combination medical therapy (biologics plus antibiotics/immune-suppressants) for perianal fistula, with or without surgery
Compared with
patients who received surgery (non-cutting seton, fistulectomy, fecal diversion) in addition to medical therapy
Main outcome
clinical and MRI characteristics of complex perianal fistula, including presence of abscess and treatment received
Quality
This is a small, descriptive cross-sectional study without a comparison group or reported outcomes for abscess treatment specifically.
Limitations
Single-centre, cross-sectional design with only 27 patients, all with Crohn's-related complex fistula rather than simple anorectal abscess, and no outcome data on abscess resolution with or without surgery.
Taken word for word from the abstract
- n 27 (15.42%)
- population patients with fistulizing perianal CD, who underwent pelvic MRI between January 2020 and December 2021, was performed
- intervention Combination therapy with biologics and antibiotics/immune-suppressants were the most commonly prescribed medical therapy.
- comparator Six (22.22%) patients underwent combined medical and surgical (non-cutting seton, fistulectomy, fecal diversion) treatment.
- primaryOutcome The clinical (age, sex, disease duration, disease location and behavior, disease activity [Perianal Disease Activity Index, PDAI] and treatment received) and radiological (number and location of fistulae, extensions, number and location of internal and external openings, fistula activity, presence or absence of perianal abscess and associated proctitis) characteristics of complex perianal fistula
- result Six (22.22%) patients underwent combined medical and surgical (non-cutting seton, fistulectomy, fecal diversion) treatment.
Indian J Gastroenterol · PMID 37548863 · Read it on PubMed ↗
Dalili et al. 2023
Autologous Platelet-Rich Plasma Injection and Platelet-Rich Fibrin Glue Insertion for the Treatment of Extensive Supralevator Anorectal Fistula: A Case Report
Fistula healed after platelet therapy.Case seriesVery low qualityRelated question
1 people11-month follow-up
after treatment, no voiding dysfunction, constipation, diarrhea, or fistula infection at follow-up
Who was studied
a 59-year-old man with a deep anorectal abscess and subsequent fistula
What they received
platelet-rich plasma injection and platelet-rich fibrin glue for fistula closure
Compared with
none (single patient, before/after own treatment course)
Main outcome
fistula healing and symptoms like voiding problems, constipation, diarrhea, or infection
Quality
this is a single patient case report, so it cannot show whether this treatment works in general.
Limitations
single case report; abscess was treated with surgical drainage and debridement first, and the platelet therapy was used later for the resulting fistula, not as an alternative to surgery for the abscess itself
Taken word for word from the abstract
- n A 59-year-old man was admitted with pelvic pain and fever.
- population A 59-year-old man was admitted with pelvic pain and fever.
- intervention Platelet-rich plasma was injected around the fistula into the tissue, and platelet-rich fibrin glue was introduced to the fistula tract.
- comparator He was managed with antibiotics, abscess drainage, repeated radical surgical debridement, and necrosectomy.
- primaryOutcome At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection.
- result At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection.
World J Plast Surg · PMID 37220581 · Read it on PubMed ↗
Jwa et al. 2022
Gluteal and Presacral Abscess Due to Crohn's Disease with Multiple Fistulas
Antibiotics alone failed, needed surgery.Case seriesVery low qualityRelated question
1 people2022
Antibiotics alone failed and the abscess got worse with fever; surgery to drain the abscess resolved the pain and fever
Who was studied
Young man with Crohn's disease who developed abscesses near the buttock and lower back area
What they received
Antibiotics alone (piperacillin/tazobactam) first, then surgical drainage
Compared with
Antibiotics alone versus surgical drainage
Main outcome
Whether the abscess resolved and symptoms (pain, fever) went away
Quality
This is a single case report of an unusual, more complex abscess type (not simple perianal abscess) due to Crohn's disease, so it can't show whether typical anorectal abscess can avoid surgery.
Limitations
Single case, unusual abscess location tied to Crohn's disease complicated by fistulas, not a typical isolated anorectal abscess.
Taken word for word from the abstract
- n A 21-year-old male was admitted with right buttock and lower back pain
- population A 21-year-old male was admitted with right buttock and lower back pain with a duration of 3 months. He had a history of CD in the small intestine diagnosed 10 months previously.
- intervention Treatment was started with piperacillin/ tazobactam antibiotic but patient developed a fever and abscess extent was aggravated. Therefore, surgical incision and drainage was performed and 4 Penrose drains were inserted.
- comparator Treatment was started with piperacillin/ tazobactam antibiotic but patient developed a fever and abscess extent was aggravated. Therefore, surgical incision and drainage was performed
- primaryOutcome Patient's pain and fever were resolved following surgery.
- result Treatment was started with piperacillin/ tazobactam antibiotic but patient developed a fever and abscess extent was aggravated. Therefore, surgical incision and drainage was performed and 4 Penrose drains were inserted. Patient's pain and fever were resolved following surgery.
Korean J Gastroenterol · PMID 36567440 · Read it on PubMed ↗
Orellana Olmedo et al. 2022
Perianal Abscess Following Excisional Hemorrhoidectomy in an Immunocompetent Patient
Drained abscess with antibiotics, resolvedCase seriesVery low qualityRelated question
1 people2022
the patient was successfully managed with incision and drainage with antibiotics
Who was studied
44-year-old man with no immune problems who developed a perianal abscess after hemorrhoid surgery
What they received
incision and drainage of the abscess plus antibiotics
Main outcome
whether the abscess resolved after treatment
Quality
this is a single patient case report, so it cannot show whether avoiding surgery works in general.
Limitations
single case report, no comparison group, and the treatment used (incision and drainage) is itself a surgical procedure rather than a non-surgical alternative
Taken word for word from the abstract
- n 44-year-old immunocompetent male
- population a 44-year-old immunocompetent male with grade II and III hemorrhoidal disease who underwent excisional hemorrhoidectomy that was complicated with perianal abscesses
- intervention The patient was successfully managed with incision and drainage with antibiotics
- primaryOutcome The patient was successfully managed with incision and drainage with antibiotics
- result The patient was successfully managed with incision and drainage with antibiotics
Cureus · PMID 36514644 · Read it on PubMed ↗
Simsek 2022
Perianal Infections in Patients With Hematologic Malignancy: The Risk of Fournier's Gangrene Leading to Mortality and Irreversible Organ Damage
Severe infection often needed surgery anyway.Case seriesVery low qualityRelated question
4 people2022
one of four patients died despite antibiotics and surgery; one needed testicle removal
Who was studied
adults with blood cancer who developed perianal infection that progressed to Fournier's gangrene
What they received
antibiotics first, then surgical debridement (with diverting ostomy in most cases)
Compared with
no comparator, single-group case series
Main outcome
death
Quality
This is a tiny retrospective case series of only 4 patients with a severe, different condition (gangrene, not simple abscess), so it cannot show whether surgery can be avoided.
Limitations
Very small sample (n=4), retrospective, no control group, and focuses on a rare complication (Fournier's gangrene) in immunocompromised cancer patients rather than typical anorectal abscess.
Taken word for word from the abstract
- population 4 adults with hematologic malignancy who developed perianal infection progressing to FG
- intervention A broad-spectrum antibiotic regimen was administered as initial empiric therapy at onset of fever and was de-escalated based on the culture results and clinical response.
- intervention All patients underwent surgical debridement, and diverting ostomy was performed in 3 cases.
- comparator The data of 4 adults with hematologic malignancy who developed perianal infection progressing to FG between January 2010 and December 2018 were reviewed retrospectively.
- primaryOutcome The primary outcome was mortality.
- result One patient died of overwhelming sepsis (25%), and 1 patient required orchiectomy (25%).
- n Four male patients with a mean age of 36.75 years
Wounds · PMID 34928812 · Read it on PubMed ↗
Dosis et al. 2021
Perianal Actinomycosis: A Surgeon's Perspective and Review of Literature
Needed both antibiotics and surgery.RetrospectiveVery low qualityRelated question
5 people2021
all identified perianal actinomycosis cases required both prolonged antibiotics and surgical treatment
Who was studied
patients with perianal actinomycosis infection (a rare bacterial cause of anorectal disease)
What they received
prolonged antibiotic therapy plus surgery
Compared with
no comparator group; description of treatment used in these cases
Main outcome
whether infection was eradicated with treatment
Quality
This is a tiny retrospective case series (5 relevant patients) of a rare specific infection, not a controlled study of typical anorectal abscess.
Limitations
Retrospective design, very small number of perianal cases, no control group, and findings specific to a rare bacterial cause (Actinomyces) rather than typical anorectal abscess.
Taken word for word from the abstract
- population Primary perianal actinomycosis is rare and challenging for the colorectal surgeon.
- n Five cases of perianal actinomycosis were identified requiring prolonged antibiotic and surgical therapy.
- intervention requiring prolonged antibiotic and surgical therapy
- comparator The site of infection and treatment strategy were examined.
- primaryOutcome An extended course of antibiotic therapy (months) is required for eradication in certain cases.
- result Five cases of perianal actinomycosis were identified requiring prolonged antibiotic and surgical therapy.
Ann Coloproctol · PMID 34731938 · Read it on PubMed ↗
Sun et al. 2021
Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report
Needed surgery despite antibiotics.Case seriesVery low qualityRelated question
1 people27 days of admission
the patient required two surgical debridements along with antibiotics before recovering and being discharged
Who was studied
a 53-year-old patient with a gas-producing perianal abscess
What they received
antibiotics (ceftizoxime and ornidazole, later meropenem and vancomycin) plus debridement and drainage surgery
Compared with
none reported
Main outcome
resolution of infection and successful identification of causative bacteria
Quality
this is a single patient case report, so it cannot show whether avoiding surgery works in general.
Limitations
single case, no comparison group, and the abscess was a rare gas-producing clostridial/coli coinfection rather than a typical anorectal abscess.
Taken word for word from the abstract
- population a 53-year-old patient who was admitted to the hospital for a gas-producing perianal abscess
- intervention The patient was managed with ceftizoxime and ornidazole and then received debridement and drainage at the lesion on the second day after admission
- intervention The patient was then successfully treated with meropenem and vancomycin
- comparator CASE PRESENTATION
- primaryOutcome Timely pathogen identification is critical for treating gas-producing perianal abscess
- result a second debridement and drainage were performed 4 days after the primary operation
- result was discharged at 27 days of admission
- n a 53-year-old patient
- followUp was discharged at 27 days of admission
Gut Pathog · PMID 34645489 · Read it on PubMed ↗
Ali et al. 2021
Multidrug Resistance and Flaring up of Manifestation in Fistulizing Crohn's Disease after Surgery on a Perianal Lesion
Found harmCase seriesVery low qualityRelated question
1 people2021
developed delayed wound healing with highly drug-resistant bacterial infection after abscess surgery
Who was studied
48-year-old woman with Crohn's disease and a perianal abscess
What they received
surgical incision and drainage of the abscess
Compared with
none reported
Main outcome
wound healing and infection after surgery
Quality
This is a single patient case report, so it cannot show whether surgery or non-surgical treatment is better for most people.
Limitations
Single case report with no comparison group, so findings may not apply broadly; the abstract itself calls for surgery rather than testing an alternative.
Taken word for word from the abstract
- n a 48-year-old woman
- population 48-year-old woman with known case of Crohn's disease who presented with massive swelling in the perianal region
- intervention surgical incision and drainage
- comparator Antibiotics and surgical incision and drainage have been successful in treating perianal disease.
- primaryOutcome culture sensitivity was done due to delayed wound healing and passage of greenish discharge
- result it revealed highly resistant bacteria Proteus mirabilis, Escherichia coli, and Staphylococci
Case Rep Gastroenterol · PMID 34616267 · Read it on PubMed ↗
Schwandner 2021
Stem cell injection for complex anal fistula in Crohn's disease: A single-center experience
Fistula healed in two-thirds; abscess still occurred in some.RetrospectiveVery low qualityRelated question
12 peoplemean 14.3 (range: 3-30) mo
66.7% (8 of 12) of fistulas healed, but 33.3% of patients later needed surgery again for a new perianal abscess
Who was studied
adults with complex anal fistula caused by Crohn's disease, without active disease or abscess
What they received
local injection of stem cells (darvadstrocel) into the fistula after seton removal and surgical preparation
Compared with
none - single group before/after comparison
Main outcome
fistula healing rate
Quality
Only 12 patients were studied without a comparison group, and the data were looked at after the fact, so the results could easily be due to chance or selection.
Limitations
small number of patients, retrospective analysis, no control group, and patients with abscess were excluded from treatment
Taken word for word from the abstract
- population All patients with complex anal fistulas associated with Crohn's disease who were amenable for definite fistula closure within a defined observation period were potential candidates for stem cell injection
- intervention Local injection of darvadstrocel was performed as a standardized procedure under general anesthesia including single-shot antibiotic prophylaxis, removal of seton drainage, fistula curettage, closure of the internal openings and local stem cell injection.
- comparator Data were retrospectively analyzed.
- primaryOutcome Data collection focusing on healing rates, occurrence of abscess and follow-up was performed on a regular basis of quality control and patient care.
- result a healing rate was documented in 66.7% (8/12); mean duration to achieve healing was 12 (range: 6-30) wk. Within follow-up, 4 patients required reoperation due to perianal abscess (33.3%).
- n 12 patients (6 females, 6 males) with a mean age of 42.5 (range: 26-61) years underwent stem cell therapy.
World J Gastroenterol · PMID 34239275 · Read it on PubMed ↗
Ohzu et al. 2021
Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate?
Surgery helped when antibiotics failed.Case seriesVery low quality
1 peopleday 21 (fever resolution); patient later died of leukemia progression
antibiotics failed; surgery (fistulotomy with debridement) eventually controlled infection and fever resolved
Who was studied
man with neutropenia and acute myeloid leukemia with an anorectal abscess
What they received
surgical treatment of abscess (incision and drainage, later fistulotomy with debridement)
Compared with
initial antibiotic treatment alone
Main outcome
resolution of abscess and fever
Quality
This is a single patient case report, so it cannot reliably show whether surgery works better than non-surgical treatment.
Limitations
Single case report with no comparison group; patient had multiple confounding treatments including chemotherapy.
Taken word for word from the abstract
- n A 56-year-old man presented with an ischiorectal abscess.
- population A 56-year-old man presented with an ischiorectal abscess. Preoperative laboratory test results revealed leukocytopenia and anemia. He was diagnosed with acute myeloid leukemia.
- intervention followed by fistulotomy of the abscess with extensive debridement of cellulitis on day 6
- comparator Antibiotic treatment was ineffective, and fever persisted.
- primaryOutcome The patient's fever resolved on day 21.
- result Surgical treatments can prevent fatal progression of anorectal abscess, even during neutropenia.
Am J Case Rep · PMID 34218249 · Read it on PubMed ↗
Vuyyuru et al. 2020
Long-term outcomes in perianal fistulizing Crohn's disease in a resource-limited setting: A cohort analysis
Looked at fistula surgery, not abscess careRetrospectiveLow qualityRelated question
65 peoplemedian duration of follow-up of 45 (IQR, 24-66) months
complete response rates were 25% with immunomodulators, 42.8% with fistula surgery, 39.5% with biologicals, and 45.4% with diversion, but relapse was highest after surgery; absence of an abscess predicted long-term complete closure
Who was studied
patients with perianal fistula due to Crohn's disease
What they received
medical therapy (immunomodulators and biological drugs)
Compared with
fistula surgery or fecal diversion surgery
Main outcome
complete closure of the perianal fistula
Quality
This is a small, retrospective, single-setting cohort of Crohn's fistula patients, not a controlled study of abscess treatment itself.
Limitations
Retrospective record review, resource-limited single-center setting, and the study addresses fistula management in Crohn's disease rather than treatment of anorectal abscess as the primary question.
Taken word for word from the abstract
- n 65 were included in the final analysis
- population We retrospectively analyzed records of patients with perianal fistulizing CD who were prospectively followed from January 2005 to December 2018
- intervention Complete response rates with immunomodulators, fistula surgery, biologicals, and diversion were 25%, 42.8%, 39.5%, and 45.4%, respectively
- comparator Complete response rates with immunomodulators, fistula surgery, biologicals, and diversion were 25%, 42.8%, 39.5%, and 45.4%, respectively
- primaryOutcome The absence of perianal abscess was associated with complete fistula closure
- result Complete response rates with immunomodulators, fistula surgery, biologicals, and diversion were 25%, 42.8%, 39.5%, and 45.4%, respectively. The relapse rate was highest after fistula surgery (52.6%)
- result Absence of perianal abscess predicts long-term complete fistula closure
- followUp median duration of follow-up of 45 (IQR, 24-66) months
Indian J Gastroenterol · PMID 33040321 · Read it on PubMed ↗
Mohamedahmed et al. 2021
Incision and drainage of cutaneous abscess with or without cavity packing: a systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials
Packing didn't help after drainage.Meta-analysisLow qualityRelated question
485 people2021
no significant difference between packing and no packing for recurrence, fistula, or need for a second procedure
Who was studied
patients with cutaneous abscess (including some with anorectal abscess) who had incision and drainage
What they received
incision and drainage of the abscess followed by packing of the cavity
Compared with
incision and drainage of the abscess without packing of the cavity
Main outcome
abscess coming back, need for a second procedure, or forming an abnormal tunnel (fistula)
Quality
it pools only eight trials with 485 patients and the authors' own additional analysis says the results are not conclusive and could be missing a true difference.
Limitations
Trial Sequential Analysis showed the meta-analysis was not conclusive and recurrence results were subject to type 2 error; both groups still underwent surgical incision and drainage rather than a non-surgical treatment.
Taken word for word from the abstract
- n Eight RCTs reporting a total number of 485 patients who underwent incision and drainage of cutaneous abscess with (n = 243) or without (n = 242) packing of the abscess cavity were included.
- population all randomised controlled trials (RCTs) comparing incision and drainage of cutaneous abscess with and without packing were included
- population The results remained unchanged on sub-group analyses for ano-rectal abscess, paediatric patients, adult patients, and the use of antibiotics.
- intervention incision and drainage of cutaneous abscess with and without packing
- comparator incision and drainage of cutaneous abscess with and without packing
- primaryOutcome Abscess recurrence at maximum follow-up period, need for second intervention, and development of fistula in-ano were the evaluated outcome parameters for the meta-analysis
- result There was no significant difference in the risk of recurrence (risk ratio (RR) 1.31, P = 0.56), fistula-in-ano (RR 0.63, P = 0.28), and need for second intervention (RR 0.70, P = 0.05) between two groups.
- limitations The Trial Sequential Analysis demonstrated that the meta-analysis was not conclusive, and the results for recurrence were subject to type 2 error.
Langenbecks Arch Surg · PMID 32740696 · Read it on PubMed ↗
Bałaż et al. 2020
Perianal abscess and fistula-in-ano in children - evaluation of treatment efficacy. Is it possible to avoid recurrence?
Surgery beat minimally invasive treatment for recurrence.RetrospectiveLow qualityRelated question
24 people2020
patients treated with fistulotomy had no recurrence or incontinence, while those previously managed with incision and drainage elsewhere had more severe disease, needed further surgery, longer antibiotics and hospital stay
Who was studied
infants and children with perianal abscess and fistula-in-ano
What they received
minimally invasive treatment (sitz baths, antibiotics, or incision and drainage) without definitive fistula surgery
Compared with
fistulotomy and fistulectomy surgery to treat the underlying fistula
Main outcome
recurrence of perianal abscess and fecal incontinence
Quality
This is a small, retrospective study with only 24 patients and no randomization, so the comparison between groups may be biased.
Limitations
Retrospective design, small sample size, and comparison groups defined by where patients were first treated rather than random assignment.
Taken word for word from the abstract
- population Perianal abscess and fistula-in-ano are common findings in infants and children.
- n The retrospective study included 24 infants with perianal abscess treated at our center between 2013 and 2015.
- intervention Minimally invasive approach (sitz baths, antibiotic therapy, puncture or incision and drainage of the abscess) appears tempting due to its simplicity and lack of need for general anesthesia, but it is associated with a high recurrence rate.
- comparator Fistulotomy and fistulectomy, which are slightly more invasive procedures, significantly reduce the recurrence rate of fistulain- ano and perianal abscess.
- primaryOutcome No fecal incontinence or recurrence of perianal abscess were observed in any of our patients.
- result In group II, the disorder was associated with severe inflammation, some patients underwent an additional surgical intervention, such as incision and drainage of an extensive buttock's abscess; patients required longer antibiotic therapy and prolonged hospitalization.
Pol Przegl Chir · PMID 32312918 · Read it on PubMed ↗
Zhu et al. 2019
The pathogens and curative effects analysis of perianal abscess of infants under 3 months
Surgery plus antibiotics recommended, not non-surgical treatment.RetrospectiveLow qualityRelated question
66 people2019
after incision, 6.6% of infants developed an anal fistula compared with 60.3% of adults, a significant difference
Who was studied
infants under 3 months old with perianal (anorectal) abscess
What they received
surgical incision of the abscess along with antibiotics matched to the bacteria found
Compared with
adults with perianal abscess treated the same way (historical comparison group)
Main outcome
rate of anal fistula complication after abscess incision
Quality
this is a small retrospective chart review comparing infants to a historical adult group, with no comparison to non-surgical treatment and no randomization.
Limitations
retrospective design, no control group treated without surgery, comparison to adults rather than to a non-surgical approach
Taken word for word from the abstract
- population 66 cases of perianal abscess of infants under 3 months
- intervention simple surgical intervention and synchronous sensitive antibiotic administration are suggested as the optimal management
- comparator 60.3％ in the adult group
- primaryOutcome the complication rate of anal fistula was 6.6％ in infants under 3 months and 60.3％ in the adult group
- result After abscess incision, the complication rate of anal fistula was 6.6％ in infants under 3 months and 60.3％ in the adult group. There was significant difference P＜0.01.
- n 66 cases of perianal abscess of infants under 3 months
Turk J Pediatr · PMID 31559720 · Read it on PubMed ↗
Samuk et al. 2019
Perianal abscess in infants: Amenable to conservative treatment in selected cases
Most avoided surgery with antibiotics.Case seriesLow quality
19 people22.4 months
76.4% of infants avoided surgery, though 15.7% eventually required surgical drainage and recurrence occurred in some
Who was studied
infants under 2 years old with perianal abscess
What they received
conservative treatment (antibiotics, without surgery) for selected abscess cases
Compared with
surgical drainage (historical/alternative approach, not a formal comparison group)
Main outcome
whether surgical drainage was ultimately needed
Quality
This was a small, retrospective review of selected patients without a control group, so it can't reliably prove conservative treatment works as well as surgery.
Limitations
Retrospective design, small sample, selection of 'suitable' cases only, two patients lost to follow-up, high recurrence rate
Taken word for word from the abstract
- n Data of 19 patients aged <24 months treated conservatively for perianal abscess at a tertiary hospital in 2014-2018 were retrospectively reviewed.
- population Data of 19 patients aged <24 months treated conservatively for perianal abscess
- intervention evaluate the outcomes of conservative approach in selected cases of perianal abscesses in infants
- comparator the most frequent approach is drainage with/without fistulotomy
- primaryOutcome Three patients (15.7%) ultimately required surgical drainage
- result surgical intervention was prevented in 13/17 patients (76.4%) available for follow up
- followUp During follow up (mean, 22.4 months)
Pediatr Int · PMID 31469939 · Read it on PubMed ↗
Obst et al. 2019
Early-stage Management of Complex Wounds Using Negative Pressure Wound Therapy With Instillation and a Dressing With Through Holes
Wound improved without surgery closure unknown.Case seriesVery low qualityRelated question
6 people2019
wound healing progressed with no complications in all cases, but wounds were not followed to closure or grafting
Who was studied
patients with complex wounds including pressure ulcers, necrotizing soft tissue infection, perianal abscess, and abdominal wound
What they received
negative pressure wound therapy with instillation and dwell time using a dressing with through holes, plus antibiotics and surgical debridement when appropriate
Compared with
none (case series, no comparison group)
Main outcome
progression of wound healing and formation of granulation tissue
Quality
This is a tiny, uncontrolled case series of only 6 patients with mixed wound types, including just one perianal abscess, so it cannot show whether this therapy avoids surgery for anorectal abscess specifically.
Limitations
Small sample size, no control group, mixed wound types with only one perianal abscess case, patients also received antibiotics and debridement, and outcomes were not followed to full closure.
Taken word for word from the abstract
- n There were 6 patients (3 men, 3 women; average age, 58.5 years) treated.
- population Wound types included 3 pressure ulcers, 1 necrotizing soft tissue infection, 1 perianal abscess, and 1 large abdominal wound.
- intervention negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a novel reticulated open-cell foam dressing with through holes (ROCF-CC)
- comparator Patients received antibiotics and surgical debridement when appropriate.
- primaryOutcome In all cases, progression of wound healing was observed with no complications.
- result This method produced viable granulation tissue and wound bed preparation; however, patients were not followed to closure or grafting.
Wounds · PMID 31184590 · Read it on PubMed ↗
Kanstrup et al. 2019
[Perianal abscess after anal intercourse should raise suspicion of rectal gonorrhoeae infection]
Surgery plus antibiotics healed abscessCase seriesVery low qualityRelated question
1 peoplesix weeks
abscess was drained surgically and treated with antibiotics; six weeks later ultrasound showed scarring but no fistula
Who was studied
young man with anal pain and fever after anal sex, found to have rectal gonorrhoea
What they received
surgical incision of the abscess plus antibiotics for gonorrhoea
Compared with
none
Main outcome
healing of abscess and resolution of suspected fistula
Quality
this is a single patient case report, so it cannot show whether surgery can be avoided
Limitations
single case report; abscess was treated with surgery, not used to test avoiding surgery; no comparison group
Taken word for word from the abstract
- n This case report describes a younger man
- population a younger man, who experienced increasing anal pain and later fever after anal intercourse. N. gonorrhoeae infection was verified, before a clinical examination revealed a perianal abscess
- intervention six weeks after primary surgery and treatment with relevant antibiotics
- comparator treatment with relevant antibiotics
- primaryOutcome transanal ultrasonography showed perianal scarring and no signs of anocutaneous fistula
- result six weeks after primary surgery and treatment with relevant antibiotics, transanal ultrasonography showed perianal scarring and no signs of anocutaneous fistula
Ugeskr Laeger · PMID 30799811 · Read it on PubMed ↗
Mak et al. 2018
Significant Medical and Surgical Morbidity in Perianal Crohn's Disease: Results from a Territory-Wide Study
Most still needed surgery eventually.RegistryLow qualityRelated question
283 people106 months
most patients still ended up needing surgery despite multiple courses of antibiotics, with surgery probability reaching about 78% by 8 years
Who was studied
adults with Crohn's disease who had perianal involvement (including fistulas and abscesses), from a Hong Kong IBD registry
What they received
antibiotics and biologic drugs used to manage perianal Crohn's disease
Compared with
surgical procedures (including abscess drainage, defunctioning surgery, proctectomy)
Main outcome
how often patients eventually needed biologics versus surgery over time
Quality
this is a retrospective registry study of a specific Crohn's disease population, not a controlled comparison of abscess treatments, so it gives only indirect, uncontrolled evidence.
Limitations
retrospective registry design, no control group, mixes fistula and abscess cases together, and focuses on Crohn's disease patients rather than typical anorectal abscess patients
Taken word for word from the abstract
- population Consecutive patients with PCD were identified from the HKIBDR
- n 283 [28.8%] had perianal involvement
- intervention 70 [29.2%] required ≥5 courses of antibiotics
- intervention Eighty-four patients [34.7%] received biologics
- comparator 98 [40.5%] had ≥2 surgical procedures
- comparator Nine patients required defunctioning surgery and 4 required proctectomy
- primaryOutcome Cumulative probabilities for use of biologics were 4.7%, 5.8%, and 8.6% at 12 months, 36 months, and 96 months, respectively, while the probabilities for surgery were 67.2%, 71.6%, and 77.7%, respectively.
- result Patients with PCD had poor outcome, with young age of onset, multiple antibiotic use, and repeated surgery.
J Crohns Colitis · PMID 30165543 · Read it on PubMed ↗
Mandolfino et al. 2018
SECCA procedure for anal incontinence and antibiotic treatment: a case report of anal abscess
Longer antibiotics may prevent abscess.Case seriesVery low qualityRelated question
1 people2018
the authors suggest a longer antibiotic course may reduce the chance of abscess, based on this single case
Who was studied
a 66-year-old woman with gas and fecal incontinence who developed an anal abscess after a SECCA radiofrequency procedure
What they received
a full antibiotic course of at least 6 days after the SECCA procedure
Compared with
a short-term 24-hour antibiotic therapy
Main outcome
occurrence of anal abscess after the SECCA procedure
Quality
it is a single case report with no comparison group, so it cannot show whether antibiotics alone can treat an abscess
Limitations
single case report; no control group; suggestion is speculative, not tested
Taken word for word from the abstract
- population a rare case of an anal abscess related to a SECCA procedure in a 66-year-old woman affected by gas and FI for twenty years
- intervention administering antibiotic therapy to patients and to run a full course of at least 6 days
- comparator rather than a short-term (24 h) therapy
- primaryOutcome to minimize the incidence of this complication
- result We suggest that this finding could consolidate the importance of administering antibiotic therapy to patients and to run a full course of at least 6 days rather than a short-term (24 h) therapy
- n a 66-year-old woman
BMC Surg · PMID 30086744 · Read it on PubMed ↗
Yamana 2018
Japanese Practice Guidelines for Anal Disorders II. Anal fistula
Surgery usually needed, rarely resolves alone.GuidelineVery low qualityRelated question
size not given2018
As spontaneous recovery is rare, except in the case of children, surgery is the principle approach to anal fistulas.
Who was studied
people with anorectal (anal) abscess or fistula
What they received
antibiotics or incision and drainage for anal abscess
Compared with
surgery for anal fistula
Main outcome
whether the condition resolves without surgical treatment
Quality
This is a general practice guideline summarizing common knowledge and expert recommendations, not a study with original patient data or statistics.
Limitations
The abstract is a general guideline summary without specific patient numbers, study design details, or outcome data; it mainly addresses anal fistula rather than abscess alone.
Taken word for word from the abstract
- population Anal abscess symptoms include sudden onset of anal pain, swelling, redness, and fever.
- intervention Antibiotics should be administered in cases of perianal abscess with surrounding cellulitis, or concomitant systemic disease, or those not alleviated by incision and drainage.
- comparator As spontaneous recovery is rare, except in the case of children, surgery is the principle approach to anal fistulas.
- primaryOutcome As spontaneous recovery is rare, except in the case of children, surgery is the principle approach to anal fistulas.
- result As spontaneous recovery is rare, except in the case of children, surgery is the principle approach to anal fistulas.
J Anus Rectum Colon · PMID 31559351 · Read it on PubMed ↗
Barry et al. 2018
Congenital Perirectal Dermoid Cyst: A Rare Cause of Complex, Recurrent Pediatric Fistula-in-ano
Rare case, surgery neededCase seriesVery low qualityRelated question
1 people2018
the fistula was complex and recurrent, caused by a rare congenital cyst, and did not resolve with standard treatment
Who was studied
an 8-year-old boy with recurrent anal fistula
What they received
standard treatments for fistula-in-ano (not specified in detail)
Compared with
none
Main outcome
resolution of the fistula/abscess
Quality
this is a single patient case report, so it cannot show whether non-surgical treatment generally works
Limitations
single case report of an unusual underlying cause (congenital dermoid cyst), not representative of typical anorectal abscess
Taken word for word from the abstract
- population an 8-year-old boy with a complex, recurrent fistula-in-ano
- result resulted from a rare congenital perirectal dermoid cyst
- primaryOutcome complex, recurrent fistula-in-ano
- n an 8-year-old boy
- intervention often resolve with oral antibiotics; occasionally they require drainage or fistulotomy
- comparator alternative diagnoses should be considered in cases of recurrent abscesses and fistulae that are refractory to standard treatments
Front Pediatr · PMID 29868530 · Read it on PubMed ↗
Lourtet Hascoet et al. 2018
Clinical diagnostic and therapeutic aspects of 221 consecutive anorectal Chlamydia trachomatis and Neisseria gonorrhoeae sexually transmitted infections among men who have sex with men
Most abscess patients avoided surgery.Prospective cohortVery low qualityRelated question
221 people2018
27 patients (13.9%) developed anal abscesses, and of these 14 (7.2% of the total) went on to have surgery for anal fistula
Who was studied
men who have sex with men with anorectal chlamydia or gonorrhoea infection (proctitis)
What they received
antibiotic treatment for the STI (azithromycin/ceftriaxone, excluding quinolones)
Main outcome
clinical, diagnostic and therapeutic aspects of the infections, including rates of anal abscess and surgery
Quality
This is a descriptive case series of STI patients without a control group comparing surgical versus non-surgical abscess care, so it cannot show whether abscess can be treated without surgery.
Limitations
Observational, no comparison group, focused on STI diagnosis/treatment rather than abscess management; abscess and surgery numbers are incidental findings.
Taken word for word from the abstract
- n On 441 rectal samples collected, 221 (50.1%) were positive
- population all MSM consulting for proctitis at proctology Institute-Saint-Joseph's Hospital, Paris, were included
- intervention the association of recommended antibiotics excluding quinolones
- primaryOutcome This study describes their clinical, diagnostic and therapeutic aspects.
- result Anal abscesses were found for 27 (13.9%) patients, and 14 (7.2%) of them underwent surgery for anal fistula.
Int J Infect Dis · PMID 29608959 · Read it on PubMed ↗
López et al. 2018
Comparative Study of Drainage and Antibiotics versus Drainage Only in the Management of Primary Subcutaneous Abscesses
Antibiotics added nothing after drainage.Randomised trialLow qualityRelated question
165 people7 days
no significant difference in resolution between antibiotics and placebo
Who was studied
patients with skin abscesses needing drainage, including some perianal abscesses
What they received
antibiotics after incision and drainage
Compared with
placebo after incision and drainage
Main outcome
abscess resolved by day 7
Quality
This was a randomized trial, but it studied general skin abscesses (not specifically anorectal) and all patients still had surgical drainage, so it does not test surgery versus no-surgery.
Limitations
Both groups underwent surgical drainage; the study compares antibiotics vs placebo after drainage, not surgery vs no surgery, and perianal abscesses were only a subset of cases with uneven distribution between groups.
Taken word for word from the abstract
- n One hundred sixty-five patients were included for analysis.
- population Chest and peri-anal abscesses were statistically more frequent in group 2
- intervention Patients were randomly assigned either to receive antibiotic agents (group 1) or placebo (group 2) after I&D.
- comparator placebo (group 2) after I&D
- primaryOutcome The primary end point was resolution rate of the abscess at the seventh day.
- result Resolution rate was 96% in group 1 and 93% in group 2, with no statistical difference between both (p = 0.28).
Surg Infect (Larchmt) · PMID 29596040 · Read it on PubMed ↗
Zalieckas 2017
Treatment of perianal Crohn's disease
No clear answer given.Narrative reviewVery low qualityRelated question
size not given2017
abstract does not report a specific result; states treatment is less successful than in patients without Crohn's related perianal disease
Who was studied
patients with perianal Crohn's disease
What they received
multimodal approach to therapy including medical and surgical modalities
Main outcome
managing symptoms while maintaining continence
Quality
this is a general review article with no study data, numbers, or specific outcomes reported, so it carries little weight for this question.
Limitations
no methodology, no data, no specific findings on abscess treatment without surgery are given
Taken word for word from the abstract
- population Perianal Crohn's is a common manifestation of Crohn's disease.
- intervention A multimodal approach to therapy including medical and surgical modalities is often necessary.
- primaryOutcome The goal of treatment is to manage symptoms while maintaining continence.
- result treatment is less successful than in those patients without Crohn's related perianal disease
Semin Pediatr Surg · PMID 29126509 · Read it on PubMed ↗
Dryden et al. 2017
Comparison of Stromal Vascular Fraction with or Without a Novel Bioscaffold to Fibrin Glue in a Porcine Model of Mechanically Induced Anorectal Fistula
Cell-scaffold therapy healed fistulas in pigsAnimal studyVery low qualityRelated question
17 people4 weeks
All fistulas treated with cells plus scaffold healed, compared with only some treated with cells alone and none treated with fibrin glue
Who was studied
Pigs with surgically created anorectal fistulas (a model of Crohn's-related fistula, not human abscess)
What they received
Stromal vascular fraction (fat-derived cells) injected alone or combined with a bioabsorbable scaffold
Compared with
Fibrin glue treatment of the fistula
Main outcome
Whether the fistula tract healed by week 2
Quality
This is a small animal experiment on surgically made fistulas, not a human study of abscess treatment, so it gives only indirect, low-certainty evidence.
Limitations
Small number of animals per group, a mechanically created fistula model in pigs rather than naturally occurring disease, and no human data; also studies fistula healing, not whether an abscess itself can be managed without surgery.
Taken word for word from the abstract
- population ARFs were mechanically created and matured by setons.
- intervention periaortic fat was harvested and processed for stromal vascular fraction (SVF). The cells were labeled with a membrane stain for later identification, then injected into the fistula or implanted through scaffold.
- comparator Fistulas not treated with cells were injected with fibrin glue.
- primaryOutcome Animals were monitored visually for healing at weeks 2 and 4, then euthanized to evaluate fistulas for histologic healing.
- result All fistulas (6/6) treated with SVF + scaffolds healed by week 2, compared with only 4/6 with just SVF and 0/5 treated with fibrin glue.
- n All fistulas (6/6) treated with SVF + scaffolds healed by week 2, compared with only 4/6 with just SVF and 0/5 treated with fibrin glue.
- followUp Animals were monitored visually for healing at weeks 2 and 4
Inflamm Bowel Dis · PMID 28945635 · Read it on PubMed ↗
Rayen et al. 2017
The long-term outcome of anti-TNF alpha therapy in perianal Crohn's disease
Drug helped symptoms, rarely cured fistulas.RetrospectiveLow qualityRelated question
75 people2017
73% of patients responded overall, but complete healing on MRI was rare, and those with prior abscess drainage were less likely to respond
Who was studied
adults with perianal Crohn's disease
What they received
anti-TNF alpha drug therapy
Compared with
patients with different fistula types and prior treatment history (no drug comparator)
Main outcome
response to anti-TNF therapy (clinical, MRI healing, need for surgery)
Quality
This was a retrospective single-center review without a control group, so it cannot reliably show whether treatment caused the outcomes.
Limitations
Retrospective design, single center, no control group, and the abstract notes MRI often did not confirm clinical healing.
Taken word for word from the abstract
- n The study included 75 adult patients with perianal Crohn's disease commenced on anti-tumour necrosis factor alpha therapy from January 2000 to December 2012.
- population 75 adult patients with perianal Crohn's disease
- intervention anti-tumour necrosis factor alpha therapy
- comparator Patients that had taken antibiotics and those that had previously required abscess drainage were less likely to respond to treatment
- primaryOutcome Response to treatment was determined from records relating to clinical evaluation, magnetic resonance imaging follow-up and whether further surgical intervention was required.
- result 73% (55) of all patients and 38 of the 57 (67%) patients with perianal fistulas responded to anti-tumour necrosis factor alpha therapy.
- result Five of the 57 (13%) patients with perianal fistulas demonstrated complete healing on clinical evaluation; however, magnetic resonance imaging confirmed complete healing in only two.
- result Patients that had taken antibiotics and those that had previously required abscess drainage were less likely to respond to treatment [relative risk (RR) = 0.707 and 0.615, respectively; p = 0.03, p = 0.0001].
Tech Coloproctol · PMID 28066859 · Read it on PubMed ↗
Klag et al. 2015
Medical Therapy of Perianal Crohn's Disease
Drugs help but surgery still used.Narrative reviewLow qualityRelated question
size not given2015
medical drugs can help close fistulas but the review says they should be combined with surgery, not replace it
Who was studied
people with Crohn's disease who have fistulas or abscesses around the anus
What they received
antibiotics, immune-suppressing drugs, and anti-TNF biologic therapy
Compared with
not clearly compared against surgery alone
Main outcome
healing or closure of perianal fistulas/abscesses
Quality
this is a narrative literature review of selected articles, not a controlled study, so it can't reliably show whether surgery can be avoided.
Limitations
non-systematic selection of 36 articles, no original patient data, and focuses on Crohn's-related fistulas rather than typical anorectal abscess without surgery
Taken word for word from the abstract
- population perianal fistulas are a common feature of Crohn's disease (CD)
- intervention Antibiotics, thiopurines, and calcineurin inhibitors are useful agents in the management of perianal CD.
- comparator should be combined with surgical measures
- primaryOutcome fistula healing seems to be possible in a substantial proportion of patients
- result Antibiotics and several immunosuppressive drugs have improved the treatment of fistulizing CD and should be combined with surgical measures.
Viszeralmedizin · PMID 26557835 · Read it on PubMed ↗
Horsager et al. 2015
[Perianal abscesses in twins]
Outcome not reported in abstract.Case seriesVery low quality
2 people2015
Who was studied
29-day-old twin baby boys with perianal abscesses
What they received
conservative (non-surgical) management
Compared with
incision and drainage (surgery)
Main outcome
resolution of perianal abscess
Quality
This is a report of just two infants, so it cannot reliably show whether non-surgical treatment works.
Limitations
Only two patients described; abstract does not report their treatment outcome, and aetiology and antibiotic effectiveness remain unproven.
Taken word for word from the abstract
- n two 29-day-old monozygous twin boys with PA
- population two 29-day-old monozygous twin boys with PA
- intervention several studies suggest conservative management
- comparator Traditionally, incision and drainage has been the treatment of choice
- primaryOutcome In this case report we present two 29-day-old monozygous twin boys with PA.
Ugeskr Laeger · PMID 26240046 · Read it on PubMed ↗
Futami et al. 2015
[Surgical treatment for perianal Crohn's disease]
No clear answer on abscess aloneNarrative reviewVery low qualityRelated question
size not given2015
medications alone are hard to maintain long-term remission with; surgery is often needed but carries recurrence and incontinence risk, so the goal has shifted to reducing drainage rather than complete closure
Who was studied
people with perianal Crohn's disease (fistula, abscess, ulcers, etc.)
What they received
medications (antibiotics, immunosuppressants, anti-TNF) and surgical options such as fistulotomy, seton drainage, diverting stoma
Compared with
different surgical techniques and medical therapy compared to each other
Main outcome
maintaining remission and anal function / symptom control
Quality
This is a narrative overview summarizing general treatment experience, not a controlled study, so it cannot reliably show whether abscess can be treated without surgery.
Limitations
Narrative review with no original data, no defined study population or outcome measures, and focused on fistula management rather than abscess specifically.
Taken word for word from the abstract
- population Perianal lesions are a frequent complication of Crohn's disease (CD) and include fistula, abscess, anal ulcer, skin tag, anal stricture, and carcinoma.
- intervention The condition is treated with medications such as antibiotics, immunosuppressants, or anti-tumor necrosis factor agents.
- intervention Surgical therapy is selected according to the type of fistula and can include conventional fistulotomy, seton drainage, diverting stoma, and anorectal amputation.
- result However, it is difficult to maintain long-term remission.
- result After fistulotomy, recurrence is frequent and there is an increased risk of incontinence.
- result Currently, the goal of therapy for these patients has shifted from complete fistula closure to reducing drainage from the fistula to improve their quality of life.
- comparator Seton drainage is the preferred treatment to improve symptoms and preserve anal function.
- primaryOutcome Ongoing careful management is important to control anal symptoms and maintain long-term anal function in the treatment of patients with CD
Nihon Geka Gakkai Zasshi · PMID 26050507 · Read it on PubMed ↗
Jeong et al. 2015
Perianal Abscess and Proctitis by Klebsiella pneumoniae
Antibiotics failed; needed surgery.Case seriesVery low qualityRelated question
1 people2015
Antibiotics alone did not resolve the infection; lesions worsened and surgery with drainage was required, after which he improved
Who was studied
61-year-old man with diabetes and history of alcohol abuse, with abdominal and anal pain
What they received
antibiotics alone (ciprofloxacin and metronidazole) initially, then surgery after worsening
Main outcome
resolution of perianal/perirectal abscess and proctitis
Quality
This is a single case report, so it cannot reliably show whether non-surgical treatment works in general.
Limitations
Single patient case report with an unusual, invasive bacterial cause (ESBL-producing K. pneumoniae) in a patient with diabetes and alcoholism, limiting generalizability.
Taken word for word from the abstract
- n A 61-year-old man with diabetes mellitus and a history of alcohol abuse presented with abdominal and anal pain for two weeks.
- population A 61-year-old man with diabetes mellitus and a history of alcohol abuse presented with abdominal and anal pain for two weeks.
- intervention The patient was treated with ciprofloxacin and metronidazole.
- intervention The patient underwent laparoscopic sigmoid colostomy and perirectal abscess incision and drainage.
- primaryOutcome showed a perianal and perirectal abscess
- result The lesions were aggravated and seemed webbed in appearance because of damage to the rectal mucosa.
- result He improved after surgery and was discharged.
Intest Res · PMID 25691848 · Read it on PubMed ↗
Ribière et al. 2014
[Management of intestinal complications in inflammatory bowel diseases]
Drainage plus antibiotics, surgery if needed.Narrative reviewVery low qualityRelated question
size not given2014
abscesses are drained and treated with antibiotics, but surgery is usually required if obstructive signs persist after the abscess resolves
Who was studied
patients with Crohn's disease who develop abdominal, pelvic or perianal abscesses
What they received
abscess drainage combined with antibiotics, and for perianal abscess drainage with non-tight setons plus antibiotics and anti-TNF therapy
Compared with
surgery (resection)
Main outcome
need for surgery after abscess management
Quality
this is a narrative expert review summarizing management recommendations without original study data, a defined outcome measure, or sample size.
Limitations
No study design, methodology, or outcome data are reported; this is a general narrative review of IBD complication management rather than a study of anorectal abscess treatment in the general population.
Taken word for word from the abstract
- population For Crohn's disease (CD), it is mainly strictures, fistulas and abdominal or pelvic abscess in luminal forms and perianal lesions (ulcers, fissures, fistula/abscess) in the perineal forms.
- intervention Abdomino-pelvic abscess should be drained if the size is greater than 4-5 cm and treated with antibiotics.
- intervention Anoperineal abscess must be drained by non-tight setons.
- intervention Medical treatment also involves antibiotics and antiTNF, usually in combotherapy.
- comparator If obstructive signs are present after the resolution of the abscess, surgery is usually required.
- result Abdomino-pelvic abscess should be drained if the size is greater than 4-5 cm and treated with antibiotics. If obstructive signs are present after the resolution of the abscess, surgery is usually required.
- primaryOutcome If obstructive signs are present after the resolution of the abscess, surgery is usually required.
Rev Prat · PMID 25638864 · Read it on PubMed ↗
Ghosh et al. 2014
Role of immunosuppressives in special situations: perianal disease and postoperative period
Abscess drainage still needed first.Narrative reviewVery low qualityRelated question
size not given2014
abscess drainage and seton placement were described as necessary before starting immunosuppressant or anti-TNF therapy
Who was studied
patients with perianal Crohn's disease, including complex fistulising disease
What they received
immunosuppressants (azathioprine, anti-TNF, tacrolimus, thalidomide) with or without surgical drainage/seton
Compared with
no treatment or conventional management
Main outcome
need for perianal surgery and disease recurrence
Quality
this is a narrative review of Crohn's disease drug therapy, not a study testing whether abscesses can be managed without surgery, and it explicitly says drainage is needed first.
Limitations
abstract focuses on perianal Crohn's disease management with drugs, not on whether abscess drainage can be avoided; no original study design or patient numbers given for this specific question.
Taken word for word from the abstract
- population Complex perianal disease is associated with poor outcome and requires early effective therapy.
- intervention antibiotics, immunosuppressants and anti-TNF therapy are required
- comparator azathioprine/6-mercaptopurine was associated with a significantly reduced risk of clinical recurrence
- primaryOutcome a higher cumulative proportion of patients in the azathioprine group were free of perianal surgery
- result Drainage of any abscess at examination under anaesthesia and seton insertion are important before introduction of immunosuppressants and anti-TNF therapy.
Dig Dis · PMID 25531359 · Read it on PubMed ↗
Chavada et al. 2014
Uncommon manifestations of Listeria monocytogenes infection
Abscess treated with surgery and antibiotics together.Case seriesVery low qualityRelated question
3 people2014
All three patients, including the one with perianal abscess, were treated with antibiotics and surgery with favourable outcomes
Who was studied
Patients with unusual Listeria monocytogenes infections, including one with a perianal abscess
What they received
Antibiotics plus surgery
Compared with
None
Main outcome
Clinical outcome after treatment
Quality
This is a tiny case series of only three unrelated patients with different infections, not a controlled study of abscess treatment, so it cannot show whether surgery can be avoided.
Limitations
Only three cases reported, mixed infection types and sites, no comparison group, surgery was combined with antibiotics in all cases so their individual contributions cannot be separated.
Taken word for word from the abstract
- n Three unrelated cases of unique focal infections caused by Listeria monocytogenes are presented.
- population 3) A 60 year old Asian man with perianal abscess.
- intervention They were managed with antibiotics and surgery with favourable outcomes.
- comparator They were managed with antibiotics and surgery with favourable outcomes.
- primaryOutcome They were managed with antibiotics and surgery with favourable outcomes.
- result They were managed with antibiotics and surgery with favourable outcomes.
BMC Infect Dis · PMID 25466213 · Read it on PubMed ↗
Shoji et al. 2014
Currarino syndrome in an adult presenting with a presacral abscess: a case report
Drainage worked short-term; surgery followed later.Case seriesVery low qualityRelated question
1 peoplefour years and six months after surgery
symptoms disappeared after drainage and antibiotics, but excision surgery was still performed three months later
Who was studied
32-year-old man with Currarino syndrome and a presacral abscess
What they received
abscess drainage through a perianal approach combined with antibiotics
Compared with
no non-surgical comparator; later radical excision surgery
Main outcome
resolution of infection symptoms and abscess
Quality
this is a single patient case report, so it cannot show whether this approach works in general
Limitations
single case report of a rare congenital condition (Currarino syndrome) rather than a typical anorectal abscess, with no comparison group
Taken word for word from the abstract
- population A 32-year-old Japanese man presented with fever, arthralgia and buttock pain.
- intervention The abscess was drained by a perianal approach with our patient treated with antibiotics.
- comparator After three months, an excision was performed through a posterior sagittal approach.
- primaryOutcome His symptoms soon disappeared.
- result Abscess drainage followed by radical surgery resulted in a successful outcome.
- n A 32-year-old Japanese man presented with fever, arthralgia and buttock pain.
J Med Case Rep · PMID 24571710 · Read it on PubMed ↗
Tonkić et al. 2013
[Treatment of fistulizing Crohn's disease]
Abscess drainage recommended, not avoided.Narrative reviewVery low qualityRelated question
size not given2013
the abstract states that if a perianal abscess is present it should be drained urgently, and complex perianal disease needs combined drug and surgical treatment
Who was studied
people with Crohn's disease who have fistulas (abnormal tunnels) connecting the bowel to other organs or skin, including perianal fistulas and abscesses
What they received
antibiotics, immunosuppressants, anti-TNF drugs, seton placement, and surgical drainage for perianal disease
Compared with
different treatment approaches compared to each other depending on fistula type and severity
Main outcome
whether fistulas and abscesses heal or resolve with different treatment approaches
Quality
this is an expert narrative review summarizing treatment recommendations, not a study with original data comparing surgical versus non-surgical abscess treatment
Limitations
the abstract is a general review of Crohn's fistula treatment, not a study specifically testing whether abscesses can be treated without surgery, and no controlled trials are described for this question
Taken word for word from the abstract
- population The treatment of fistulating Crohn's disease should include a combined medical and surgical approach
- intervention Antibiotics (metronidazole and ciprofloxacine) are useful for treating complex perianal disease
- intervention azathioprine/6-mercaptopurine is the first line medical therapy for complex perianal disease, which is always given in combination with surgical therapy (seton, fistulotomy/fistulectomy)
- intervention Anti TNF-alpha agents (infliximab and adalimumab) should be used as a second choice medical treatment
- comparator In refractory and extensive complex perianal disease a diverting stoma or proctectomy should be performed
- result The presence of a perianal abscess should be ascertained and if present should be drained urgently
- result In case of a complex perianal disease, seton placement should also be recommended
- primaryOutcome There are no controlled-randomized trials to assess the effect of medical treatment for non-perianal fistulating Crohn's disease
Acta Med Croatica · PMID 24471302 · Read it on PubMed ↗
Mattila et al. 2013
Extraintestinal Clostridium difficile infections
Does not address abscess treatment choice.RetrospectiveVery low qualityRelated question
31 people1-year
mortality and disease severity were linked to patients' underlying illnesses, not to any treatment comparison
Who was studied
patients with extraintestinal Clostridium difficile infections, including some with perianal abscesses
What they received
none - this study did not test a treatment, it characterized infections
Main outcome
clinical features and risk factors of extraintestinal C. difficile infections
Quality
this is a small retrospective chart review with no treatment comparison, so it cannot show whether surgery or non-surgical treatment works better for abscesses
Limitations
retrospective record review, very small subgroup with perianal abscess, no comparison of treatments, mostly focused on bacteriology and mortality rather than abscess management
Taken word for word from the abstract
- n Extraintestinal CDI was found in 31 patients
- population 4 had perianal abscesses
- intervention Our objective was to characterize clinical features and risk factors of these infections.
- primaryOutcome to characterize clinical features and risk factors of these infections
- result The 1-year mortality rate was 36% and it correlated with the severity of underlying diseases.
- followUp The 1-year mortality rate was 36%
Clin Infect Dis · PMID 23771984 · Read it on PubMed ↗
Garrick et al. 2013
A multidisciplinary team model of caring for patients with perianal Crohn's disease incorporating a literature review, topical therapy and personal practice
Combined therapy, not surgery alone, works best.Narrative reviewVery low qualityRelated question
size not given2013
a combination of medical and surgical treatment, including topical wound care, is suggested to give the best outcomes
Who was studied
patients with perianal Crohn's disease
What they received
antibiotic therapy, immunosuppression, immunomodulation and topical wound management (honey and silver dressings)
Compared with
surgery alone versus combined medical and surgical treatment
Main outcome
overall management and disease outcomes in perianal Crohn's disease, not a single defined outcome
Quality
this is a narrative literature review and personal practice summary, not a controlled study testing abscess treatment without surgery.
Limitations
abstract does not describe a specific study design, patient numbers, or controlled comparison; it is an expert review and recommendation piece.
Taken word for word from the abstract
- population Perianal CD involves areas of chronic abscess formation, ulceration, skin tags or fistula formation.
- intervention Current practice focuses predominantly on the use of antibiotic therapy, immunosuppression, immunomodulation and surgery.
- comparator The majority of evidence suggests that a combination of medical and surgical management produces the best disease outcomes.
- primaryOutcome This review covers the management of perianal CD and provides recommendations for practice for the multidisciplinary team (MDT)
- result A combination of treatment modalities that includes topical wound management is likely to produce the best patient outcomes.
Frontline Gastroenterol · PMID 28839719 · Read it on PubMed ↗
Hogan et al. 2013
Beware the ischiorectal abscess
Improved without surgery, but risky.Case seriesVery low qualityRelated question
1 people2013
the abscess eventually drained spontaneously through the skin and the patient's sepsis improved, but conservative management of this condition is linked to up to 30% mortality
Who was studied
65-year-old man with an ischiorectal (anorectal) abscess that had formed a connection to the spinal canal
What they received
non-surgical management with antibiotics after the patient refused definitive surgery
Compared with
standard surgical treatment of the abscess
Main outcome
resolution of infection and clinical improvement
Quality
this is a single unusual case report with no comparison group, so it can't show whether avoiding surgery is generally safe or effective.
Limitations
single case, highly atypical abscess connected to a spinal defect, patient refused surgery by choice rather than by medical trial, no control group
Taken word for word from the abstract
- n A previously healthy sixty-five year old man presented emergently with rectal pain, weight loss and recurrent severe tension headaches.
- population A previously healthy sixty-five year old man presented emergently with rectal pain, weight loss and recurrent severe tension headaches.
- intervention He was treated with broad spectrum antibiotics and a neurosurgical opinion was sought.
- intervention The patient in this case was adamant that he did not consent to definitive surgical intervention.
- comparator In fit healthy patients surgery is the mainstay of treatment as myelomengingoceles do not regress spontaneously.
- result He remained clinically unwell (septic and coagulopathic) until the abscess fistulated through the perianal skin, draining pus mixed with clear fluid (likely CSF) at which point he improved systemically.
- result Conservative management is associated with up to 30% mortality (largely due to bacterial meningitis).
- primaryOutcome He remained clinically unwell (septic and coagulopathic) until the abscess fistulated through the perianal skin, draining pus mixed with clear fluid (likely CSF) at which point he improved systemically.
Int J Surg Case Rep · PMID 23396392 · Read it on PubMed ↗
Hvas et al. 2011
Diagnosis and treatment of fistulising Crohn's disease
Abscesses should be drained, per review.Narrative reviewVery low qualityRelated question
size not given2011
the review states that any abscess should be drained, and that fistula treatments vary from antibiotics and medication to surgery depending on complexity
Who was studied
people with Crohn's disease who develop fistulas (abnormal connections between the bowel and other organs or skin)
What they received
various treatments for Crohn's-related fistulas and abscesses, including drainage, antibiotics, immune-suppressing drugs, and surgery
Compared with
different treatment approaches compared to each other within the review
Main outcome
closure of fistulas and absence of abscesses
Quality
this is a general review article about Crohn's disease fistulas, not a study designed to test whether abscesses can be treated without surgery, and it does not report original data or a specific comparison for abscess treatment alone.
Limitations
This abstract is about fistula treatment in Crohn's disease patients specifically, not about anorectal abscess treatment in general; it is a narrative review without original patient data on abscess management alone.
Taken word for word from the abstract
- population Fistulas are discovered in up to 25% of all Crohn's disease patients during long-term follow-up examinations.
- intervention Any abscess should be drained, and the disease extent throughout the entire gastrointestinal tract should be evaluated.
- result Any abscess should be drained, and the disease extent throughout the entire gastrointestinal tract should be evaluated.
- primaryOutcome Treatment goals for perianal fistulas include reduced fistula secretion or none, evaluated by clinical examination; the absence of abscesses; and patient satisfaction.
- comparator Fistulotomy is considered for simple perianal fistulas. In complex perianal fistulas, antibiotics and azathioprine or 6-mercaptopurine, which are often combined with a loose seton, constitute the first-line medical therapy.
Dan Med Bull · PMID 21975159 · Read it on PubMed ↗
Kawahara et al. 2011
Management of perianal abscess with hainosankyuto in neonates and young infants
Herbal medicine cured most infants.Case seriesVery low quality
15 peoplemedian 28 days (range, 14-117 days)
14 of 15 infants were cured without recurrence, most within 28-60 days
Who was studied
male infants under 3 months old with perianal abscess
What they received
oral traditional Japanese herbal medicine (hainosankyuto, TJ-122)
Compared with
none (no surgery or antibiotics used)
Main outcome
cure of perianal abscess without recurrence
Quality
this is a small, uncontrolled case series without a comparison group, so it cannot reliably prove the treatment works better than surgery or no treatment.
Limitations
no control group, small sample size, all male infants, no comparison to surgical treatment or placebo
Taken word for word from the abstract
- population Fifteen male infants with PA under the age of 3 months were reviewed.
- intervention TJ-122 was administered at a dose of 0.20 g/kg/day (n= 13) or 0.25 g/kg/day (n= 2) orally in two or three divided doses before meals.
- comparator Antibiotics were not used in any of the patients.
- primaryOutcome Of the 15 patients, 14 were cured and had no recurrence
- result Of the 15 patients, 14 were cured and had no recurrence, with a median TJ-122 administration of 28 days (range, 14-117 days). Eight patients were cured within 28 days (53%) and 12 were cured within 60 days (80%).
- n Fifteen male infants with PA under the age of 3 months were reviewed.
Pediatr Int · PMID 21575105 · Read it on PubMed ↗
Gligorijević et al. 2010
The role of pelvic MRI in assesment of combined surgical and infliximab treatment for perianal Crohn's disease
Found a benefitProspective cohortLow qualityRelated question
24 people8 weeks
PDAI score dropped significantly after infliximab, with 46% complete response and MRI showing remission in most re-scanned patients
Who was studied
patients with perianal Crohn's disease
What they received
combined surgical treatment (seton placement) plus infliximab infusions, with MRI assessment
Compared with
before versus after infliximab treatment (no separate control group)
Main outcome
fistula activity score (PDAI) and MRI-assessed remission of fistula/abscess
Quality
Small uncontrolled group with no comparison arm, so it's hard to know how much benefit came from surgery versus the drug.
Limitations
No control group, small sample size, and treatment combined surgery (seton) with infliximab rather than testing non-surgical treatment alone.
Taken word for word from the abstract
- n 24 patients with signs of PACD were prospectively evaluated
- population 24 patients with signs of PACD were prospectively evaluated
- intervention started on Infliximab 5 mg/kg (IFX) at 0, 2 and 6 weeks induction protocol
- intervention Surgical examination under anesthesia (EUA) was performed and non-cutting seton placed where appropriate
- comparator Pelvic MRI was performed in each patient before Infliximab treatment, and in half of the patients after IFX
- primaryOutcome Perianal Disease Activity Index (PDAI) was calculated to evaluate perianal fistulae activity
- result Median PDAI before and 8 weeks after IFX treatment was 8.3 +/- 2.08 and 3.5 +/- 1.03, respectively (p = 0.00064)
- result complete response (no drainage) in 11/24 (46%) patients
Acta Chir Iugosl · PMID 21066991 · Read it on PubMed ↗
Ulug et al. 2010
The evaluation of bacteriology in perianal abscesses of 81 adult patients
Identified common bacteria, not treatment effectiveness.Case seriesLow qualityRelated question
81 people2010
aerobic bacteria (not anaerobic) were the most common organisms found
Who was studied
adult patients with perianal abscesses
What they received
not applicable (microbiological analysis of abscess specimens)
Compared with
not applicable, no treatment comparison made
Main outcome
types of bacteria causing the abscesses
Quality
This is a small, non-comparative case series that only looked at bacteria types and did not test or compare surgical versus non-surgical treatment.
Limitations
No comparison of treatment approaches (surgery vs no surgery) was made; study only describes bacteriology, all patients presumably underwent drainage as standard care.
Taken word for word from the abstract
- n 81 consecutive adult patients with perianal abscesses
- population 81 consecutive adult patients with perianal abscesses, who presented at a university hospital in Diyarbakir
- primaryOutcome it is important to identify the causative organisms; therefore, we accessed the microbiological analysis of these patients
- result this study demonstrated that aerobic organisms are the predominant isolates in these infections
- intervention Treatment of perianal abscesses requires prompt surgical drainage and antimicrobial therapy
- comparator there is no evidence that uncomplicated perianal abscesses can be safely treated only with drainage
Braz J Infect Dis · PMID 20835504 · Read it on PubMed ↗
Lewis et al. 2010
Anorectal Crohn's disease
Review says abscesses need draining, not avoidance.Narrative reviewVery low qualityRelated question
size not given2010
abstract states abscesses should be drained surgically alongside medical therapy; does not report outcomes of avoiding surgery
Who was studied
people with Crohn's disease affecting the anus or rectum
What they received
combined medical and surgical treatment (draining abscess, setons, antibiotics, immunosuppressive drugs like infliximab)
Main outcome
successful treatment of perianal fistula/abscess disease
Quality
this is a general review of treatment approach, not a study with measured outcomes comparing surgery versus no surgery for abscess.
Limitations
abstract is a narrative review describing general treatment strategy, not an original study with data on abscess drainage versus non-surgical treatment.
Taken word for word from the abstract
- population Crohn's disease manifests with perianal or rectal symptoms in approximately one-third of patients
- intervention Any abscess should be drained and setons placed if there is active rectal inflammation or complex fistulae. Antibiotics and immunosuppressive therapy (especially with infliximab) should also be initiated.
- result Any abscess should be drained and setons placed if there is active rectal inflammation or complex fistulae.
- primaryOutcome combined medical and surgical intervention when treating perianal fistulae has been shown to offer the best chance for success
Surg Clin North Am · PMID 20109634 · Read it on PubMed ↗
Brown et al. 2009
Perirectal abscess infections related to MRSA: a prevalent and underrecognized pathogen
MRSA common, antibiotics often inadequate.RetrospectiveLow qualityRelated question
124 people2009
MRSA was found in 19% of cases, and when it was present, antibiotics only adequately covered it 33% of the time
Who was studied
adults with a perirectal (anorectal) abscess
What they received
antibiotics given together with incision and drainage
Compared with
incision and drainage without matched antibiotic coverage / cases where antibiotics were not adequate for the organism
Main outcome
how common MRSA was in the abscess cultures and whether prescribed antibiotics actually covered the bacteria found
Quality
it is a retrospective chart review over 8 years with no comparison of surgical versus non-surgical outcomes, so it can't show whether abscesses can be treated without surgery.
Limitations
Retrospective design, cultures were only taken in 52% of patients, no randomization, and no direct comparison of surgery versus no surgery as treatment.
Taken word for word from the abstract
- n In all, 124 patients were treated for perirectal abscess during the 8-year period.
- design We conducted a retrospective study of all adult patients who presented with a perirectal abscess.
- population all adult patients who presented with a perirectal abscess
- intervention 35% of patients were given antibiotics coupled with incision and drainage
- comparator The antibiotics offered adequate coverage when compared with the sensitivities of the organisms 73% of the time.
- primaryOutcome The prevalence of MRSA in our patient population was 19%, and when this organism was cultured, the patient only received adequate coverage 33% of the time.
- result The prevalence of MRSA in our patient population was 19%, and when this organism was cultured, the patient only received adequate coverage 33% of the time.
J Surg Educ · PMID 20005498 · Read it on PubMed ↗
de Parades et al. 2008
[Cryptoglandular anal fistulas]
Surgery needed; antibiotics alone not enough.Narrative reviewLow quality
size not given2008
Antibiotics are not useful for initial treatment; the abscess needs urgent surgical incision, and surgical fistulotomy is very effective but can risk incontinence, leading to interest in sphincter-sparing alternatives
Who was studied
people with cryptoglandular anal fistulas (a type of perianal infection)
What they received
incision of the abscess under local anaesthesia, followed by surgical fistulotomy
Compared with
antibiotic therapy alone, or sphincter-preserving techniques (rectal flap, fibrin glue)
Main outcome
getting rid of the infection and preventing recurrence
Quality
This is a narrative review describing general management principles without original patient data or comparative results.
Limitations
No original data, no patient numbers, no study design described, and no quantified outcomes are reported.
Taken word for word from the abstract
- population Cryptoglandular anal fistulae are the most frequently occurring form of perianal sepsis.
- intervention consists of its incision under local anaesthesia
- intervention surgical fistulotomy
- comparator Antibiotic therapy is not of use in initial management except in special cases.
- comparator sphincter preserving techniques using the advancement of a covering flap of rectal mucosa and the injection of fibrin glue
- primaryOutcome aims to dry up the purulent discharge and avoid recurrence of the abscess
- result Antibiotic therapy is not of use in initial management except in special cases. Treatment of an abscess, if present, is required urgently and when possible, consists of its incision under local anaesthesia.
- result These techniques are very effective in terms of eradication of the problem but there is sometimes a risk of anal incontinence.
Rev Prat · PMID 19143149 · Read it on PubMed ↗
Magdeburg et al. 2008
Perianal abscess caused by Actinomyces: report of a case
Surgery plus antibiotics healed infectionCase seriesVery low qualityRelated question
1 people2008
The infection healed after surgery and antibiotics
Who was studied
A patient with a painless perianal mass
What they received
Surgical excision plus antibiotics
Compared with
None
Main outcome
Healing of the perianal infection
Quality
This is a single patient case report, so it cannot show whether avoiding surgery would work.
Limitations
Single case report of a rare bacterial cause of abscess; surgery was still performed, so it does not address nonsurgical treatment.
Taken word for word from the abstract
- population The patient had a short history of painless perineal induration without fever or leucocytosis with normal routine blood tests.
- intervention Appropriate surgery and antibiotic treatment healed the perianal infection.
- comparator The treatment comprises excision of the abscess and. if appropriate, fistulectomy.
- primaryOutcome Appropriate surgery and antibiotic treatment healed the perianal infection.
- result Appropriate surgery and antibiotic treatment healed the perianal infection.
- n report a case of perianal actinomycosis
Tech Coloproctol · PMID 19018464 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-05
The exact search — paste this into PubMed to repeat it: ("Anal Canal"[Mesh] OR anorectal[tiab] OR perianal[tiab] OR perirectal[tiab]) AND ("Abscess"[Mesh] OR abscess[tiab]) AND ("Drainage"[Mesh] OR "incision and drainage"[tiab] OR surgical[tiab] OR surgery[tiab]) AND ("Anti-Bacterial Agents"[Mesh] OR antibiotic*[tiab] OR antimicrobial*[tiab]); PubMed expanded that to: ("Anal Canal"[MeSH Terms] OR "anorectal"[Title/Abstract] OR "perianal"[Title/Abstract] OR "perirectal"[Title/Abstract]) AND ("Abscess"[MeSH Terms] OR "Abscess"[Title/Abstract]) AND ("Drainage"[MeSH Terms] OR "incision and drainage"[Title/Abstract] OR "surgical"[Title/Abstract] OR "surgery"[Title/Abstract]) AND ("Anti-Bacterial Agents"[MeSH Terms] OR "antibiotic*"[Title/Abstract] OR "antimicrobial*"[Title/Abstract])
What came back: 283 records found · 197 read · 72 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

283records came back from the search
197were read
72actually answered the question

Why people try thisThe reasoning behind the question — not a claim that it works.

Fear of a cutting procedure and local anaesthesia in a sensitive area.
Hoping a course of pills will be simpler than scheduling a procedure.
Embarrassment about discussing or showing the area to a surgeon.
Wanting to avoid time off work or the discomfort of a wound healing open.

Common questionsShort answers, drawn from the same studies.

Can antibiotics alone cure my anal abscess?: In the one trial that tested this in adults, antibiotics alone (with a needle draw-off) worked for some people, but the abscess came back much more often than when it was properly drained. Most abscesses still need to be opened and drained.
Should I ask my doctor for antibiotics instead of a drainage procedure?: You can ask, but based on the one adult trial, drainage works more reliably. Antibiotics are sometimes added alongside drainage, especially if you have a fever, diabetes, or a weakened immune system — that's a different situation from antibiotics replacing drainage entirely.
What happens if I leave the abscess untreated and just take antibiotics?: Case reports describe adults whose infection spread and worsened on antibiotics alone, eventually needing urgent surgery. An abscess is a pocket of pus; antibiotics often can't reach it well enough on their own.
Should I stop the antibiotics I've already been prescribed?: Don't stop any prescribed antibiotic on your own. The point here is that antibiotics alone shouldn't replace drainage — talk to whoever prescribed them about whether you also need the abscess drained.
Is needle aspiration a good middle ground between pills and full surgery?: One trial tested needle aspiration plus antibiotics against standard incision and drainage, and aspiration led to more recurrences (41% versus 15%). It may still be an option in some cases, but standard drainage worked better in this trial.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.