Anorectal sepsis as a presentation of occult rectal and systemic disease

Between 1980 and 1982, 233 patients were treated for anorectal sepsis in three hospitals. The incidence of underlying disease associated with perianal sepsis and the results of surgical treatment were assessed retrospectively. Of the 233 patients who had perianal sepsis, 136 (58.4 percent) had perianal abscesses, while a further 12 (5.1 percent) had associated fistulas. Ischiorectal abscesses were found in 79 (33.9 percent) and a further two (0.9 percent) had fistulas. Four (1.8 percent) patients were found to have intersphincteric abscesses. One hundred and nine (46.8 percent) had examinations under anesthesia or definitive procedures, while the remaining 124 (53.2 percent) had incision and drainage alone. A second procedure was required by 55 (23.6 percent) patients, 40 (32 percent) in the group who had incision and drainage only and 15 (14 percent) of those having initial examinations under anesthesia (P less than .001). Twenty-seven (11.6 percent) patients had occult disease. Twelve patients (5.1 percent) had systemic disease (six diabetic, three nongastrointestinal neoplasia, two inflammatory, and 1 hematologic), while of the 109 patients who had examinations under anesthesia, 15 (6.4 percent) had associated colorectal pathology (four neoplasia, 11 inflammatory). It is important that patients with anorectal sepsis have complete medical and surgical assessments at the time of their first admission.