Anorectal emergencies

World J Gastroenterol. 2016 Jul 14;22(26):5867-78. doi: 10.3748/wjg.v22.i26.5867.


Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.

Keywords: Abscess; Anorectal; Complication; Emergencies; Fissure; Hemorrhoid; Imperforate anus; Rectal cancer; Rectal prolapse; Sepsis; Sexually transmitted disease.

Publication types

  • Editorial

MeSH terms

  • Abscess / diagnosis
  • Abscess / therapy
  • Adult
  • Anorectal Malformations / diagnosis
  • Anorectal Malformations / therapy
  • Digital Rectal Examination
  • Emergencies*
  • Endoscopy
  • Fissure in Ano / diagnosis
  • Fissure in Ano / therapy
  • Foreign Bodies / diagnosis
  • Foreign Bodies / therapy
  • Fournier Gangrene / diagnosis
  • Fournier Gangrene / therapy
  • Gastrointestinal Hemorrhage / diagnosis
  • Gastrointestinal Hemorrhage / therapy
  • Hemorrhoids / diagnosis
  • Hemorrhoids / therapy
  • Hirschsprung Disease / diagnosis
  • Hirschsprung Disease / therapy
  • Humans
  • Infant, Newborn
  • Intestinal Obstruction / diagnosis
  • Intestinal Obstruction / therapy
  • Perineum
  • Rectal Diseases / diagnosis
  • Rectal Diseases / therapy*
  • Rectal Neoplasms / diagnosis
  • Rectal Neoplasms / therapy
  • Rectal Prolapse / diagnosis
  • Rectal Prolapse / therapy
  • Rectum
  • Sexually Transmitted Diseases / diagnosis
  • Sexually Transmitted Diseases / therapy
  • Thrombosis / diagnosis
  • Thrombosis / therapy
  • Varicose Veins / diagnosis
  • Varicose Veins / therapy