ABSTRACT
This chapter discusses management of the extensive horseshoe abscess, grade four haemorrhoids, and perirectal infections in the immunocompromised patient, irreducible rectal prolapse and Fournier’s gangrene. The key to managing all patients presenting with an anorectal abscess is adequate surgical drainage, allowing the incision site to be maintained open long enough for complete drainage to occur. Special consideration should be given to patients presenting with an anorectal horseshoe abscess related to perianal manifestations of Crohn’s disease. Haemorrhoids are an extremely common anorectal condition characterised by the symptomatic enlargement and displacement of vascular cushions in the anal canal. Grade IV haemorrhoids are internal haemorrhoids that prolapse and become irreducible. Allan conducted a prospective randomised study comparing emergency haemorrhoidectomy to non-operative management and reported comparable outcomes. Patients managed non-operatively had shorter hospital stays and less sphincter damage seen on endoanal ultrasound than their acute surgical counterparts.
