Perianal sinuses in neonates and infants

Area of Science:

• Pediatric Surgery
• Proctology
• Neonatal Care

Background:

• Perianal abscesses and discharges are common in neonates and infants.
• Some cases present as perianal sinuses with blind inner ends, distinct from the anal canal.
• Histological variations exist within these pediatric perianal conditions.

Purpose of the Study:

• To evaluate the etiology of perianal abscesses, discharges, and sinuses in neonates and infants.
• To assess the effectiveness of surgical excision and primary closure for these conditions.
• To propose a diagnostic strategy for perianal sinuses in this age group.

Main Methods:

• A study of 81 neonates and infants (2 weeks to 2 years) with perianal sinuses, fistula-in-ano, or abscesses.
• Gentle probing and proctoscopy under general anesthesia were performed.
• Surgical interventions included sinus excision, fistulectomy, or abscess drainage, with histopathological examination of specimens.

Main Results:

• The majority of affected children were boys.
• 37% of cases had proper sinuses with blind inner ends; 8 showed different histological patterns, including rectal duplication in 2.
• Excision and primary closure successfully cured all patients, with non-gut derived organisms predominating in sinus discharge cultures.

Conclusions:

• Fistulae are the most common perianal discharging lesions in infants, with blind sinuses also being a significant cause.
• A diagnostic strategy for perianal sinuses involves identifying a blind tract, normal anal/rectal mucosa, and non-gut derived organisms.
• Simple excision (coring) and primary closure is an effective treatment, shortening healing time for these pediatric perianal conditions.