What are the methods for diagnosing perianal abscess?
Diagnosis of perianal abscesses can be made by combining clinical symptoms and various diagnostic methods including visual examination, palpation, digital rectal examination, and anoscopy by a physician. 1. The patient's perianal skin may show damage and inflammation, accompanied by symptoms such as itching and discharge of pus. 2. Visual Examination: Symmetrical absence of the vestibule on both sides and abnormal anal morphology. In normal individuals, when the anus is closed, it appears as an oval vertical fissure in males and a nebulous vertical fissure in females. 3. Palpation: Hard nodules can be felt in the erythematous and swollen skin around the anus, with tenderness or pulsation. 4. Digital Rectal Examination: The index finger can feel a soft mass within the anal canal, with tenderness or fluctuation, and sometimes small protrusions or depressions. If the abscess ruptures into the anal canal, pus and blood may be seen on the glove. If necessary, the index finger can be placed within the anal canal while the thumb is on the perianal skin, and pressing together can identify the area of skin with the most obvious fluctuation of the abscess. 5. During anoscopy, cryptitis can be seen under the scope, with deepened and depressed crypts, and even purulent secretions. Some abscesses, when compressed, may show the site of pus discharge, and inserting a syringe can confirm the internal opening where pus flows out, which is prone to occur during the abscess stage. During the abscess stage, the pathway of the abscess, using the two ischial tuberosities as a horizontal line, is considered with abscesses located above this line and close to the anus (3cm), typically having their internal opening in the lithotomy position.
Perianal abscesses are generally caused by infection, but the route of infection is not singular. The most common cause is direct bacterial invasion. Additionally, it is important to note that although perianal abscesses may not have a significant impact on patients in the short term, their long-term presence will certainly lead to complications.
