Two cases of anal fistula in girls evaluated for sexual abuse

Anal fistulae are seen infrequently in the pediatric population. They are most commonly encountered in otherwise healthy boys less than 1 year of age. In the scant literature regarding pediatric anal fistulae, the majority of studies and case reports involve children less than 1 year of age. Within a 2-year period 2 school age girls presented to the authors' clinic with anal fistulae without history of a perianal abscess and without predisposing factors. Both of these children had a history of sexual abuse. We believe that in an otherwise healthy school age girl the appearance of an anal fistula should raise concern for the possibility of sexual abuse.