A 50-year-old male farmer presents with a painful perianal swelling for 24 hours with fever and purulent discharge at 5 o'clock. Examination confirms a perianal abscess. The most appropriate immediate management is:

• A Antibiotics alone (piperacillin-tazobactam) and reassess in 48 hours
• B MRI pelvis to define fistula tract before drainage
• C Drainage + simultaneous fistulotomy for all tracts found at surgery
• D Incision and drainage under local anaesthesia ✓

Explanation

Acute perianal abscess requires prompt incision and drainage under local or general anaesthesia — antibiotics alone are inadequate and may mask progression to necrotizing fasciitis. MRI before drainage delays treatment and is only indicated for complex deep-space abscesses (ischiorectal, supralevator) or horseshoe abscess to define anatomy. Simultaneous fistulotomy at the time of drainage is not routinely recommended as only 50% of perianal abscesses have an identifiable fistula, and unplanned fistulotomy risks damage to the sphincter mechanism.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.