Antibiotics may have a role as adjunctive therapy in special circumstances, including valvular heart disease, immunosuppression, extensive cellulitis, or diabetes. Location of the abscess should be documented. If possible, anoscopy should be performed to reveal the primary site of infection. Patients should notify the physician if pain recurs after abscess drainage. History Patients often give a history of an abscess that either spontaneously drained or required surgical drainage.
Symptoms can include discharge, pain, swelling, or bleeding.
Physical Examination Inspection and palpation form the basis of the initial evaluation. Anoscopy may be useful to identify an internal opening. If clinically indicated, proctosigmoidoscopy or colonoscopy may be suggested to exclude more proximally located inflammatory disorders with which fistulas can be associated. Radiographic Evaluation Ultrasound, fistulography, computed tomography, and magnetic resonance imaging are not routinely indicated in the initial evaluation of fistulas but may be helpful in identifying an occult cause of recurrent fistula. May Be Treated by Fistulotomy.