ABSCESSES

Clinical Features

An abscess formation is the culmination of an uncontrolled localized infection.
There is tissue necrosis with liquefaction (pus formation).

Management

Caution should be exercised for special abscesses like mastoid abscess, as simple incision and drainage of
these can result in severe injury or in chronic sinuses.

Treatment involves:

  • Incision and drainage.
  • Use local anaesthesia lignocaine 2%.
  • An abscess needs incision and drainage. Fluctuation may be absent in deep abscess.
  • Technique of incision and drainage involves:
    • Prepare the area by cleaning and draping.
    • Test using a needle to aspirate pus if not already done.
    • Make an incision into the soft part of the abscess. Insert finger into the cavity and break all the loculi (pockets) of pus to leave a common cavity for drainage. Leave a wick of gauze (Vaseline) to facilitate drainage.
  • Breast abscess may require counter incisions, leaving in a corrugated drain for about 24 hours.
  • See ENT Section  for management of mastoid abscesses.
  • The wound(s) is/are allowed to heal by granulation.
  • Hand and foot abscesses will require multiple incisions, with counter incisions in some areas and elevation of the limbs.
  • Perianal and ischiorectal abscesses require general anaesthesia. They require days to weeks of sitz baths before they heal. Ask the patients to add 3 to 4 tablespoons of salt to the water.
  • Recurrent perianal and ischiorectal abscesses necessitate proctosigmoidoscopy to rule out anal fissures or fistulae. Recurrence may also be seen in patients with immune suppression, tuberculosis, inflammatory bowel
    diseases, and amongst homosexuals.
  • Antibiotics are indicated in hand abscesses as per sensitivity and culture report. Other abscesses may or may not need antibiotics depending on the presence or absence of local cellulites.
  • Face abscesses require antibiotic cover. Flucloxacillin 250mg 8 hourly + metronidazol 500mg 8 hourly for 5 days
  • Always send specimen of pus (and where possible abscess wall) for culture and sensitivity and histological exam