Evidence base: Perianal sepsis

Find all the latest information about clinical trials, guidelines, online resources and key texts on the management of perianal sepsis.

Perianal abscess (Photograph: SPL)
Perianal abscess (Photograph: SPL)

Clinical trials

  • Guidi L, Ratto C, Semeraro S, et al. Combined therapy with infliximab and seton drainage for perianal fistulizing Crohn's disease with anal endosonographic monitoring: a single-centre experience. Tech Coloproctol 2008; 12(2): 111-7.

This methodologically sound, prospective study has provided strong evidence for the benefit of combined use of setons and infliximab in the management of perianal sepsis in Crohn's disease.

This avoids the previous problem of healing of skin prior to obliteration of fistulous tract.

Expert opinion and literature review of the role of MRI in the management of perianal sepsis.

This systematic review has integrated the evidence on the newer approaches to fistula management that have yet to reach common practice in this country. Flap repair combined with fibrin glue treatment of fistulae may increase failure rates. Radiofrequency fistulotomy produces less pain and may allow for speedier healing.

This systematic review provides evidence that fistula surgery with abscess drainage significantly reduces recurrence or persistence of abscess/fistula or the need for repeat surgery.


  • The British Society of Gastroenterology guidelines on the management of inflammatory bowel diseases includes guidance on the medical management of fistulating perianal Crohn's disease. www.bsg.org.uk/pdf_word_docs/ibd.pdf
Key text
  • Phillips RKS. Colorectal surgery: a companion to specialist surgical practice 2009. Saunders WB.


The RCGP covers this topic in statement 15.2 of the RCGP curriculum, Digestive problems


Contributed by Miss Sophie-Anne Welchman, a specialist surgical registrar, Derriford Hospital, Plymouth, Devon


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