Same-Day Incision and Drainage of Rapidly Enlarging Perianal Abscess
Yes, you can and should have same-day incision and drainage performed by the colorectal surgeon on your first visit, especially given that your abscess is rapidly enlarging. 1
Timing of Surgical Drainage
The 2021 World Society of Emergency Surgery guidelines explicitly support immediate surgical intervention for perianal abscesses based on clinical presentation:
- Rapidly enlarging abscesses warrant emergent drainage because the timing of surgery is dictated by the severity of the clinical condition, not by scheduling convenience 1
- Surgical drainage should ideally be performed within 24 hours in patients without sepsis, immunosuppression, diabetes, or diffuse cellulitis 1
- Emergency same-day drainage is mandatory if you have any signs of sepsis (fever, rapid heart rate), immunosuppression, diabetes, or surrounding cellulitis 1
Why Same-Day Treatment Is Appropriate
Young, fit patients without signs of sepsis may have their surgery undertaken in an ambulatory (outpatient) setting, and small simple perianal abscesses can be treated under local anesthesia 1. This means:
- The colorectal surgeon can perform the procedure in their office or an outpatient surgical suite on the same day as your consultation 1
- An undrained perianal abscess can expand into adjacent spaces and progress to generalized systemic infection, making delay potentially dangerous 2
- Inadequate or delayed drainage is the principal risk factor for recurrence (up to 44% recurrence rate), so prompt, complete drainage is essential 1, 2
What to Expect During the Visit
The surgeon will:
- Perform a focused history and digital rectal examination to confirm the diagnosis 1
- Assess whether the abscess is simple (perianal or ischioanal) versus complex (intersphincteric or supralevator), which determines the drainage approach 1
- Keep the incision as close as possible to the anal verge to minimize potential fistula length while ensuring adequate drainage 1, 2
Important Caveats
The surgeon may defer same-day drainage only if:
- Imaging is needed because the presentation is atypical or a complex abscess (supralevator, horseshoe-type) is suspected 1, 2
- You have signs of sepsis requiring hospital admission and IV antibiotics before drainage 1
- The abscess is too large or complex to safely drain in an outpatient setting 2
Do not accept unnecessary delay if you are otherwise healthy and the abscess is clinically obvious—guidelines support immediate drainage in this scenario 1.