Management of Bilocular Cyst at the Anal Verge

Initial Diagnostic Approach

A focused medical history should be obtained, including duration of symptoms, presence of pain, swelling, discharge, or changes in bowel habits, to assess the patient's condition 1, 2
A complete physical examination with digital rectal examination should be performed to assess the cyst's location, size, consistency, and relationship to surrounding structures 1, 3
Signs of infection, such as erythema, warmth, fluctuance, or purulent discharge, or systemic illness should be checked for in patients with a bilocular cyst at the anal verge 1, 2

Routine biochemical investigations are not required for uncomplicated cysts without signs of infection, based on available evidence from the World Journal of Emergency Surgery 4, 5
If signs of infection or systemic illness are present, a complete blood count, inflammatory markers, and serum glucose should be obtained to rule out diabetes mellitus and assess the patient's condition 1, 3

CT scan or endoanal ultrasound are acceptable alternatives to MRI when it is unavailable or contraindicated for preoperative planning and characterization of the cyst 4, 5

Anorectal abscess should be considered in the differential diagnosis if inflammatory features are present in a patient with a bilocular cyst at the anal verge 1, 2

Complete surgical excision is indicated in all cases to establish definitive histopathologic diagnosis, rule out malignancy, and prevent complications, according to the World Journal of Emergency Surgery 6

Routine antibiotic prophylaxis is not indicated for uncomplicated cyst excision, but antibiotics are indicated if signs of infection, surrounding cellulitis, or systemic sepsis are present 2, 7
Broad-spectrum coverage should be used and a culture of cyst contents should be obtained if infection is present 2