A 28-year-old male presents with fever, exquisite anal pain that is worsened by sitting, and painful defecation. Physical examination reveals an indurated, fluctuant, erythematous, tender mass at the perianal verge. What is the appropriate initial management?

Answer and explanation

Correct answer: A. Prompt surgical incision and drainage under appropriate anesthesia

  1. Step 1: Recognize clinical pathology: Perianal abscess arising from infected anal crypt glands (cryptoglandular infection).
  2. Step 2: Apply surgical principle: An acute localized bacterial abscess with fluctuance mandates adequate incision and drainage.
  3. Step 3: Confirm management: Prompt incision and drainage prevents systemic bacteremia, supralevator extension, and extensive tissue necrosis.
Answer
Prompt surgical incision and drainage under appropriate anesthesia.
Why not the others: 'Antibiotics alone' without drainage cannot penetrate the necrotic abscess cavity and lead to chronic fistula-in-ano or sepsis; 'Topical steroids' exacerbate active infection; 'Rubber band ligation' is a treatment for internal hemorrhoids, never an acute abscess.

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