Anorectal abscesses: need for accurate anatomical localization of the disease

Anorectal abscesses constitute a common problem of the perianal area. Considerable morbidity is expected if an immediate and anatomically correct drainage procedure is not performed in a timely manner. Acute infection of an anal gland leads to the formation of the anorectal abscess, while the chronic stage of the infection appears as a fistula in ano. It is imperative to perform operations with accurate anatomical knowledge; this is particularly true in the case of fistula-in-ano and anorectal abscesses, for which inappropriate surgery can lead to disastrous results. Here we report our experience with anorectal abscesses in various locations in 14 patients. Four of the 14 had a transrectal drainage. The internal (transrectal) or external drainage of the anorectal abscesses depends mainly on the mechanism of their formation and the anatomical relationship of the abscess to the levator ani. Apart from a death occurring 1 month after drainage due to a cause not related to suppurative disease (subdural hematoma), all patients had an uneventful recovery and were discharged from hospital after a mean stay of 1.2 days. A brief and practical description of the macroscopic anatomy of the area will assist in understanding better the selection of the appropriate route of drainage of anorectal abscesses.