Should I first see the referred colorectal/general surgeon for evaluation before scheduling incision and drainage of my perineal abscess (currently on amoxicillin‑clavulanate and awaiting MRI), or can I directly schedule the surgery?

Scheduling Your Perineal Abscess Drainage

You should call the specialist surgeon's office and explain that you have an urgent referral for a perineal abscess requiring surgical drainage, and request the earliest available appointment—most likely this will be an initial evaluation visit where the surgeon will examine you and schedule the procedure, rather than directly booking surgery without being seen first. 1

Why an Initial Evaluation Visit is Necessary

The surgeon needs to personally examine you before scheduling the drainage procedure for several critical reasons:

• The World Journal of Emergency Surgery guidelines emphasize that surgical drainage requires assessment of the abscess location, size, and relationship to the anal sphincter to determine the appropriate surgical approach 1
• Your MRI results will need to be reviewed by the surgeon to rule out complex features like deep extension, fistula involvement, or connection to deeper spaces that would change the surgical plan 1
• The surgeon must perform a digital rectal examination to assess for occult supralevator extension or sphincter involvement, which determines whether simple incision and drainage is sufficient or if a seton placement is needed 1

Timing Considerations for Your Situation

Given that your abscess has grown to grape-size in just 2 days and you're already on antibiotics, you need to be seen urgently—ideally within 24-48 hours of your MRI:

• The World Journal of Emergency Surgery recommends that timing of surgery should be based on presence and severity of sepsis 1
• For fit, immunocompetent patients with small perianal abscesses without systemic signs of sepsis, outpatient management is acceptable, but rapid growth suggests you need prompt evaluation 1
• If you develop fever, increasing pain, inability to sit, or spreading redness before your specialist appointment, you should go to the emergency department for urgent drainage 1, 2

What to Communicate When Calling the Specialist

When you call the surgeon's office, specifically state:

• "I have a rapidly enlarging perineal abscess that grew from small to grape-sized in 2 days"
• "My primary care doctor referred me urgently for surgical drainage"
• "I'm currently on Augmentin and getting an MRI tomorrow"
• "I need to be seen as soon as possible after my MRI results are available"

This information signals urgency and helps the scheduler prioritize your appointment 1

The Likely Sequence of Events

Most surgical practices follow this pathway for abscess drainage:

1. Initial consultation visit (ideally within 1-3 days of referral): The surgeon examines you, reviews your MRI, confirms the diagnosis, and explains the procedure 1
2. Surgical drainage (typically scheduled within days of consultation, or same-day if urgent): Performed as an outpatient procedure under local or general anesthesia depending on abscess location and complexity 1
3. Follow-up visit (1-2 weeks post-drainage): Assessment of healing and evaluation for fistula development 2

Important Caveat About Augmentin

The antibiotics your doctor prescribed are adjunctive therapy, not primary treatment—surgical drainage is the definitive treatment:

• The World Journal of Emergency Surgery strongly recommends surgical drainage as the primary treatment for anorectal abscess, with antibiotics indicated only for surrounding cellulitis, systemic infection, or immunocompromise 1
• Antibiotics alone without drainage lead to treatment failure and progression of infection 2
• Your Augmentin may help control surrounding inflammation and prevent systemic spread, but will not resolve the abscess itself 1

Red Flags Requiring Emergency Department Visit

Go to the emergency department immediately if you develop any of these before your specialist appointment:

• Fever over 101°F (38.3°C) or chills suggesting systemic infection 1
• Rapidly spreading redness or swelling beyond the immediate abscess area 1
• Inability to urinate or have a bowel movement due to pain 1
• Severe pain not controlled by over-the-counter pain medication 1
• Feeling lightheaded, dizzy, or generally unwell suggesting sepsis 1