Delegated consent: abscess
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An abscess is a collection of pus surrounded by inflamed tissue that develops when the body tries to control an infection. It presents as a painful lump and makes the patient feel unwell. Incision and drainage (I&D) is the key treatment, which involves making a cut to drain the pus and wash out the cavity. The benefits are relief of pain and faster healing. Risks include bleeding, infection, and complications from anesthesia. For anorectal abscesses, there is also a risk of fistula or injury to the sphincter. Alternatives include antibiotics or needle drainage for small abscesses. With I&D, most patients recover fully within a day or two, but the infection could wor
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Delegated consent: abscess
- 1. Delegated consent: Abscess incision and drainage Raimundas Lunevicius, MD, FRSC Consultant Surgeon
- 2. Definition / diagnosis • A collection of pus surrounded by a wall of acutely or chronically inflammed tissue • Happens when the body tries to control infection • A painful lump & can make the patient feel unwell • Anywhere in the body • Key principle of treatment (name of the procedure): – incision & drainage – for anorectal abscess always consent for rigid sigmoidoscopy to look for internal fistula
- 3. Benefits & principles of I &D • What are the benefits of surgery? – Drainage reliefs pain, reduces cellulitis, allows better and quicker healing – Removal of cause of sepsis – ‘You should no longer have the abscess’ – ‘Surgery should prevent you from having serious complications that an abscess can cause’ • What does the operation involve? – GA / local – Cut on the skin over the abscess – Removal of the pus – Washout of the cavity – Placement of an antiseptic dressing in it
- 4. Risks common to all surgical procedures (general risks) • Injury to a blood vessel or excessive bleeding – This may require a blood transfusion. • Infection, which may require the use of antibiotics. – In rare cases, another surgical procedure may be necessary to remove the infection. • Complications with anesthesia – This may include nausea, vomiting, or in rare cases, death. • Tobacco use, excessive alcohol use and obesity can increase the risk of any surgical procedure or general anesthetic. • Any of these factors may substantially affect healing and can result in an increase of major complications including pneumonia, wound infection, blood clots in the legs and lungs, or death.
- 5. Procedure specific risks & possible complications of the proposed treatment • Reaction to local anesthetic (Xylocaine, etc.) • Recurring infection • Possible need for additional surgery • For anorectal abscess: – the life threatening Fournier's gangrene, especially in diabetic patients – fistula-in-ano – injury of sphincter
- 6. Are there any alternatives to surgery? • If an abscess is small, observation • If an abscess is small, antibiotics may work • Sometimes draining the pus with a needle can help
- 7. Recovery / prognosis in worst scenario • How soon will the patient recover after I &D? – home the same day or the day after. – return to work depending on the extent of surgery and your type of work. – most people make a full recovery and can return to normal activities. – all perianal abscesses, when drained as an emergency, should be seen in outpatient surgery clinic • Prognosis if the proposed treatment is NOT accepted: – Infection will become worse • For anorectal abscess: the life threatening Fournier's gangrene
Editor's Notes
- An abscess is a collection of pus surrounded by a wall of tissue. An abscess happens when the body tries to control infection. It causes a painful lump & can make you feel unwell You can get an abscess anywhere in the body. Abscesses are localized infections of tissue marked by a collection of pus surrounded by inflamed tissue. Abscesses may be found in any area of the body, but most abscesses presenting for urgent attention are found on the extremities, buttocks, breast, perianal area, or from a hair follicle. Abscesses begin when the normal skin barrier is breached, and microorganisms invade the underlying tissues. Causative organisms commonly include Streptococcus, Staphylococcus, enteric bacteria (perianal abscesses), or a combination of anaerobic and gram-negative organisms. Abscess resolve by drainage. Smaller (<5mm in diameter) abscesses may resolve to conservative measures (warm soaks) to promote drainage. Larger abscesses will require incision to drain them, as the increased inflammation, pus collection, and walling off of the abscess cavity diminish the effectiveness of conservative measures.
- What does the operation involve? A small abscess can be drained under a local anaesthetic but most need a general anaesthetic. The operation usually takes between ten and twenty minutes. Your surgeon will make a cut in the skin over the abscess. Once the pus has been removed, the cavity needs to heal upwards from its floor so the opening in the skin is left open. If the cavity is deep, your surgeon will place an antiseptic dressing in it.
- How soon will the patient recover? You should be able to go home the same day or the day after. Your doctor will tell you when you can return to work depending on the extent of surgery and your type of work. Most people make a full recovery and can return to normal activities.