Recurring Perianal Abscess after Seton Stitch procedure

Well, quick info:

Summer 2012, I had a bump in my right perianal region. Was misdiagnosed with a hemorrhoid and an anal fissure and finally they told me I had a perianal abscess. The day after, after about 4-5 days in deep pain, I underwent surgery; incision and drainage. I had to change the packing daily as the wound was quite deep and very close to the anus. After I got well and it completely healed, similar pain began forming in the same area. During that time I was ordered to undergo a colonoscopy which I did, and which resulted in a clear colon (yeah, sorry for posting here but I recall this was where many people discussed perianal abscesses and fistulae). I was ordered an MRI which was scheduled a very long time from then. So, until the MRI arrived it had already came out about 5 times. 3 of the times I had to undergo surgery, 2 of them global anesthetic and the other local anesthetic in a small clinic. The other two times it just drained itself. When the MRI arrived and I got the results, they told me I had a fistula. I underwent a new surgery, this time they placed a non cutting seton stitch which was meant to fall of soon after the procedure. After it fell off, I was unsure of how I was feeling so they checked me up and they said everything was ok and the fistula had gone. After about 6 months or so, the abscess came back again. This time the prof said that there was a chance that this might have happened while passing stools. He mentioned something like 'heamatoma'? Not sure, but I think he meant that a vein might have burst and resulted in the abscess forming in the same previously formed cavity. He did a small procedure: incision and drainage and he ordered an MRI again. I healed, had the MRI and it resulted in no fistula. Today 7 months after, here I am again with a lot of pain. If it is indeed the perianal abscess this would be around the 7th time (no sure, sorry I lost count) The pain is close to the same place where the abscess always comes out. I am not sure if it is the abscess or an inflamed hemorrhoid. I've had that once and as of now I can't tell which one it is more likely to be. Tomorrow im seeing the professor again.

I feel like I needed to vent out on here, so to anyone who took the time to read my long post, thanks for just reading. But this brings me to my question: did anyone have a similar experience? Recurring perianal abscess even when the fistula was confirmed to have healed several times. If yes, how? Any tips? I try to keep the area as clean as possible. To be honest, I hardly complain about the pain anymore even if it's too much to handle at times, imagine having a lump near your anus, it makes it difficult to do anything, and that is what I hate most about this. It makes me incapable to do the very simple stuff that I like doing. Thanks for reading and please help x

I am not sure I have much to offer, either. I have a fistula that never healed, but it's a bit different with Crohn's. You could ask if they would be willing to put in a permanent, non-cutting seton. This would stay in indefinitely and would allow continuous drainage of the area so the abscess won't keep returning.

Yes, keep us updated! Hemorrhoids are rough and quite painful, too. If it is the abscess, a seton being left in indefinitely may be the best way to keep that area continually draining until something else can be figured out. Sorry you're going through this! Things like this aren't really "sexy diseases" that can be talked about with just anyone lol.

That is really frustrating, I'm sorry. Is this a regular surgeon or a colo-rectal surgeon? Also, have you seen a GI? I'd also ask if you could do a scan and a barium x-ray to track the fistula.

I'm not sure I can offer any advice but I can sympathize with you. I found out I had an abscess in April of this year because I had a terrible pain in my left butt cheek area (I thought I had pulled a muscle). A month later I started discharging from my anus a pus like substance. Very scary. Went to ER and found out I had an abscess about the size of a golf all but mine was very deep, no bumps or anything on the outside. Ended up spending three days in the hospital because I was mildly septic and needed iV antibiotics. Long story short, I've had 6 surgeries since then, a mushroom catheter stuck up my bum for draining purposes (never again), two seton placements, four MRI's, a CT scan, an ultra sound and I will finally be having a colonoscopy (with possible biopsy if they see anything) on November 24th to find out if I have Crohn's. I'm seeing one of the top colon/rectal surgeons at a teaching hospital and he's never seen anything like my case in 20+ years. I still have the latest seton in place and I feel as if I should buy stock in gauze pads because I go through 3 or 4 a day due to drainage. I've had to change my life around because of all of this. But I'm persistent....I work full time, I'm a full time grad student, and I'm in a serious relationship. It takes work and it's exhausting. But I want to get better and find some answers. I've heard Crohn's hits typically in women 25-35 and I just turned 33 in August. If it turns out my scope is clear I'm not sure what I'll do. I wish you the best in everything!

Guys, thanks for reading and sharing your thoughts.
char2482, I am very sorry that you're passing from all this. I hope you'll feel better soon. Having a great surgeon you should feel better about your chances of improving.

Scifigal, thanks again. I will certainly look into the possibility of meeting another surgeon who particularly specialises in this area.

As a quick update: its been more than a week since when the pain started again. The pain significantly decreased over 2 or 3 days but never went away completely. These last 2 days the pain increased and the swelling under the wound seems to be getting bigger. It seems like the abscess began forming, suddenly stopped and continued forming again.

I am not sure what to do right now but what is sure is that if it keeps getting bigger, incision and drainage are inevitable.

@mom, I've noticed you posted lots of different things on other people's threads. It makes it hard to answer. I would suggest creating a new thread (a new topic) so you can introduce yourself to the forum and get responses in one localized place. Welcome! :)

Hey Guys, thanks for your replies to my post. As I've already said it means a lot to me; to be heard, understood and to feel like I'm not alone in something as difficult as this is. I know many of you are unfortunately in a worse situation to my pain and discomfort and though that does not make me feel better, it enlightens me with hope to not give up.

The Wednesday of last week I went to the hospital and was diagnosed with a perianal abscess on the same spot. When being examined, a female surgeon said that she thought she could feel the fistula with her finger. She was unsure if the fistula she could feel was the one causing the problem though. I thought she was the one who would carry out the procedure (proctosigmuidoscopy, incision and drainage) but in fact, she was no longer in her shift when they took me to the theatre. So another male surgeon did it. He said he will check for the fistula, if it is not very deep he will make an incision as deep as it is and eliminate it completely. If it is very deep they were going to place a seton stitch and let it heal over time.

After the surgery, I met the surgeon, he said that there was a fistula, which he laid out open (no seton stitch placed). So now I have an open wound (like the 4 other times I did this procedure), which needs cleaning and packing with dressing daily. Since, the wound is very close to the anus, it is very difficult for me to go the toilet. In fact, the dressing practically falls out on its own (let alone when I go the toilet). Thankfully, my mum has practically become my full time nurse, and she helps me clean up after I go the toilet and even clean my wound and pack it when needs be. This has made things more comfortable for me, because I can actually go the toilet whenever I want and not have to wait for the time to when I am going to the clinic and go the toilet exactly before (like the other times). The thing that is bugging me a bit is that my mum said that it seems like the outer part of the wound seems to be getting smaller in size, but the dressing seems to still be going in deep. This scares me, as I know that any space from the inside that does not completely heal until skin from further up begins closing up could form into a cavity and in turn into a fistula. Which could most probably be the reason why the same perianal abscess previously kept coming back at the same spot this many times (7 times!).

Since the dressing is falling very regularly, I am trying to make sure that I change the dressing more than once daily. That is, when I think the dressing has fallen, I change it again. This way I try to keep it packed as much as possible and avoid it closing from the top but rather grow from the root of the wound.

Does anyone have any suggestion as to what I can do to avoid leaving a cavity inside? Any ideas to how I can prevent the dressing from falling out? Or any ideas how to prevent it coming back!

Thanks again for reading my posts and comments. It means a lot.