Persistent Abscesses: When to Seek Surgical Intervention

Distress

Hello Doctor: For the past two years, I have frequently developed abscesses on my buttocks (not the anal area).
They feel like they are about to burst through the skin.
Initially, they resembled small pimples, and I used to treat them with topical medication, which worked fine.
However, sometimes they become so severe that I can't even sit down (they have grown to the size of a fist), and I have had to undergo surgery to drain the pus.
Occasionally, there are also blood clots inside.
About three months ago, I developed another one that was about the size of my thumb.
I had surgery for it, but it swelled up again afterward.
When I accidentally scratched it, it ruptured, and I treated it myself with medication.
Each time I applied the medication, I noticed there was still pus.
This has continued for two months without improvement.
Now, when it swells, it is painful to touch.
Could you please tell me what this is? Is surgery necessary, or can it be treated with medication? Which type of specialist should I consult? Thank you.

Xiao An, 10~19 year old female. Ask Date: 2005/02/18

Dr. Li Junde reply Surgery

Based on your letter, it seems that you may have a sebaceous cyst on your buttocks, which could be complicated by infection or lead to an abscess.
If it is located near the anal area, it may potentially be an anal fistula.
It is advisable to consult a general surgeon or a colorectal specialist for confirmation.
If it is a non-inflamed sebaceous cyst, surgical removal can provide a permanent solution.
In the case of an abscess, incision and drainage along with antibiotic treatment is necessary.
If it is an anal fistula, surgical intervention is required for healing.

Reply Date: 2005/02/18

More Info

Persistent abscesses, especially in the area you described, can be quite troublesome and may indicate an underlying issue that requires medical attention. Based on your description, it seems that you have been dealing with recurrent abscesses in the buttock region for the past two years, which have caused significant discomfort and have required surgical intervention in the past.

Understanding Abscesses
An abscess is a localized collection of pus that can occur in various parts of the body. It typically forms as a result of an infection, where the body’s immune system sends white blood cells to the site to fight off the invading bacteria. This accumulation of pus can lead to swelling, pain, and sometimes fever. In your case, the recurrent nature of the abscesses suggests that there may be a chronic infection or another underlying condition contributing to their formation.

When to Seek Surgical Intervention
1. Recurrent Abscesses: If you find that you are experiencing abscesses repeatedly, especially in the same location, it is crucial to consult a healthcare provider. Persistent or recurrent abscesses may not resolve with antibiotics alone and often require surgical drainage.

2. Size and Symptoms: You mentioned that the abscesses can grow quite large, sometimes to the size of a fist. Large abscesses are more likely to require surgical intervention. Additionally, if you experience increased pain, fever, or if the abscess does not improve with conservative treatment, it is a sign that surgical intervention may be necessary.

3. Failure of Conservative Treatment: If topical treatments or antibiotics have not resolved the abscess, surgical drainage may be the best option. Since you have already experienced this in the past, it may be worth considering again, especially if the abscess has not healed after two months of self-treatment.

4. Presence of Blood Clots: The presence of blood clots within the abscess can complicate the situation. This may indicate that the abscess is not only infected but also that there may be necrotic tissue that needs to be removed surgically.

Recommended Specialists
Given the nature of your condition, it would be advisable to consult with a general surgeon or a dermatologist who specializes in skin infections and abscess management. They can perform a thorough examination, possibly including imaging studies, to assess the extent of the abscess and determine the best course of action.

Conclusion
In summary, based on your symptoms and history of recurrent abscesses, it is advisable to seek medical attention. Surgical intervention may be necessary, especially if the abscess is large, painful, and has not responded to conservative treatments. A healthcare provider can help determine the best approach, whether it be surgical drainage or further medical management. It is important to address this issue promptly to avoid complications and improve your quality of life.

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