CPT® Code 46040

Incision and drainage of ischiorectal and/or perirectal abscesses is a surgical procedure aimed at alleviating the accumulation of pus in the deeper tissues surrounding the rectum. An ischiorectal abscess is specifically located in a wedge-shaped space between the ischium's tuberosity and the obturator internus muscle on the lateral side, while the medial side is bordered by the external anal sphincter and the levator ani muscle. This type of abscess can be unilateral or may extend posteriorly, potentially forming a horseshoe abscess that affects both sides. In contrast, a perirectal abscess is situated in the connective tissue adjacent to the rectum. The procedure typically begins with a digital rectal examination to accurately identify the location of the abscess. Once located, a radial or cross-shaped incision is made over the most prominent part of the abscess or the area exhibiting the greatest fluctuance. The incision edges are excised to reveal the abscess cavity, allowing for thorough drainage. During the procedure, the cavity is manually inspected, and any loculations, or pockets of pus, are broken up to ensure complete drainage. Post-drainage, the incisions may be left open to facilitate ongoing drainage, packed with iodophor gauze for a duration of 24 hours, or a drain may be placed to assist in the management of the abscess.