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Buttock Abscess

Buttock Abscess

An abscess in the buttock area is a buildup of pus that can occur either on the surface of the skin or deep within the buttock fat. There are three types of buttock abscesses: perianal abscess, ischiorectal abscess, and superficial skin abscess.

Perianal Abscess

A perianal abscess is located on the skin surface next to the anus and usually presents as a tender lump with pus discharge. It results from infected anal glands within the anal canal, and the infection tracks to the skin surface, forming a collection of pus.

Ischiorectal Abscess

An ischiorectal abscess is a deep abscess that arises within the fat tissue of the buttocks. It often causes deep-seated pain and fever without any discharge of pus. It is difficult to diagnose and may require a consultation with a general surgeon. It also arises from infected anal glands and tracks further from the anus to end up in the deep fatty tissues of the buttocks.

Superficial Skin Abscess

A superficial skin abscess can occur anywhere on the buttocks, and the patient can feel a tender skin lump that is often red and may have pus discharge. It is usually caused by a break in the skin, which allows bacteria to infiltrate. In diabetics, these abscesses can arise spontaneously without any obvious skin damage.

Pilonidal Abscess

A pilonidal abscess occurs exclusively at the region of the natal and buttock clefts. The natal cleft is the ‘valley’ between the buttocks overlying the ‘tail bone’ of the spine and the buttock cleft is the corresponding ‘valley’ between the fleshy parts of the buttocks.

The patient will experience a tender and red skin lump on either side of the cleft region,corresponding to an abscess. Some patients may, however, experience a pimple-sized nodule with occasional discharge of small amounts of pus for weeks on end.

The pilonidal abscess has a unique underlying cause. Most pilonidal abscesses occur in individuals with heavy hair growth at the buttock and cleft regions. The pilonidal abscess starts with ingrown hairat a depth ofof the ‘valley’ of the clefts that eventually form tiny hair pits. The hair pits can be identified during a specialist consult as it manifests as small pinpoint holes in the clefts. The infection then spreads from these pits to both sides of the clefts to form an abscess.

All buttock abscesses need urgent treatment to allow the pus to be drained completely. This is accomplished through minor surgery under general anaesthesia. The surgeon makes an incision/cut on the abscess to allow the pus to drain out with subsequent packing of the open wound with a special dressing material. In severe cases, the surgeon will need to remove part of the unhealthy and dead skin overlying the abscess, and this will result in a bigger wound.

It is vital for the wound to be left open and not stitched up. Stitching up the wound will re-create the abscess cavity and allow pus to re-accumulate. The wound needs to be allowed to heal from the bottom up and this healing process will take at least 2 weeks.

Superficial Skin Abscess

The superficial skin abscesses usually heal with no further recurrences, except for diabetics with poorly controlled sugar levels who may have recurring abscesses.

Perianal and Ishiocorectal Abscess

The perianal and ischiorectal abscesses arise from infected anal glands with subsequent tracking of the infection to distant areas. In up to 37% of patients with either of these conditions, the track may remain patent/open instead of closing up. As a result, there is a small communication/tract between the anal canal and the buttock skin, resulting in regular but small amounts of discharging pus from the skin and occasionally repeated development of abscesses.

Pilonidal Abscess

The initial operation to drain the pus from the abscess is the first step in the treatment of pilonidal disease. As mentioned above, the root of the problem lies in the hair pits located in the natal and buttock clefts. Removal of the hair pits is essential in ensuring a long-term cure.

The surgical techniques available include Fistulotomy with marsupialisation of skin edges, Karydakis flap procedure, Bascom procedure or a rhomboid or buttock rotation flap procedure.