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Perianal sinuses in neonates and infants

Kais M Al-Wattar1

  • 1Department of Surgery, College of Medicine, Mosul, Iraq. wattar.m@uruklink.net

Saudi Medical Journal
|January 9, 2003
PubMed

Insights

Perianal fistulae and blind sinuses are common in infants. Surgical excision and primary closure offer a cure for these conditions, with a proposed diagnostic strategy to identify sinuses before surgery.

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.
Abstract

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