Acute Perianal Disease

Perianal disease is a common problem that can present with several etiologies and appearances. Acute variations of these problems include perianal abscess and fistula, which is most commonly related to cryptoglandular disease but may be the first manifestation of Crohn’s disease; hemorrhoids, which may present with bleeding, thrombosis, or prolapsing tissue; anal fissure, which can be acute or chronic and associated with pain; or a number of other infections or acute pathology. It is important to be able to do a thorough examination to properly diagnose and treat patients with these conditions. A patient may seem to have a common or straightforward history but may actually have an underlying diagnosis of Crohn’s disease, malignancy, or an undrained abscess that may be missed without appropriate and directed questioning or a thorough examination or imaging. Basic tenets of management can vary from supportive care/expectant management to a quick incision and drainage to far more complex and definitive surgical interventions, with therapy tailored uniquely to each patient.