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Case 27: Perianal painful lump

A 26 year old man presented with a 5 day history of pain and a lump at the anal verge.

1.What operation has been performed?

The history suggests a perianal abscess was the reason for presentation, however there seems to be a soft, non-cutting seton, that has been inserted. So it would seem that an obvious internal opening was found at operation and therfore the abcess was drained and to prevent recurrence of the abscess a seton was inserted.

2. Is it always necessary to find an internal opening when draining an acute abscess?

No. Less than a third of these patients will go on to develop a fistula. So creating a false (iatrogenic) internal opening would disadvantage a lot of patients.

Important paper
A classification of fistula-in-ano. Parks AG, Br J Surg. 1976