Case history
Case history
A 32-year-old man presents to the emergency department complaining of perirectal pain and swelling. The symptoms began 24 hours earlier and have become progressively worse. The patient denies any rectal bleeding and describes the pain as very severe and localised to the area of the swelling. He relates a subjective history of fever but denies any change in bowel habits. He also denies any history of recent or chronic medical problems.
Other presentations
An anorectal abscess can be a manifestation of Crohn's disease.[1] While severe perianal pain and swelling are the most common presenting symptoms, 1 or both symptoms may be absent. Occasionally, patients with anorectal abscesses will present with urinary retention. This is more common in men with a previous history of urinary problems.[2][8]
Inter-sphincteric abscesses are very difficult to diagnose as they produce little swelling and few perianal signs of infection. In these cases anal pain is the predominant symptom, is usually described as being up inside the anal area, and is so severe that it precludes a digital rectal examination.[9]
Supra-levator abscesses may present with abdominal or deep pelvic pain mimicking an intra-abdominal condition without any obvious perirectal swelling.[10]
Rarely, patients with an anorectal abscess present with life-threatening sepsis from an associated necrotising soft-tissue infection. This is most likely in patients with diabetes, older adults, or those who are immuno-compromised or chronically debilitated.[3][11]
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