On examination, superficial abscesses will be indurated, erythematous, tender masses. Most surgeons will choose to have the wound granulate, but for sinuses that have been drained and infection controlled preoperatively, primary or Z-plasty closure can be performed. Malignant transformation is promoted by a state of immunodeficiency such as that seen with AIDS infection or with immunosuppression following organ transplantation.

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Hidradenitis, pilonidal sinus, Bartholin's gland abscess, and malignancy are in the differential diagnosis, as all of these entities may present with erythematous tender perianal masses associated with draining tracts. Surg Clin North Am 80 1:

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The pain is relieved promptly with drainage either spontaneous or surgical. Anatomy of internal and external hemorrhoid. Marsupialization of the skin edges can be performed to prevent early closure.

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Schouten WR et al: If no identifiable lesions are found to explain rectal bleeding or pain, then rigid proctosigmoidoscopy or colonoscopy may be warranted.

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Maria G et al: The upper anal canal and rectum are insensate.