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Perianal abscess in childhood.

G V S Murthi1, B O Okoye, R D Spicer

  • 1Department of Paediatric Surgery, Bristol Royal Hospital for Sick Children, St. Michaels Hill, Bristol, UK.

Pediatric Surgery International
|February 25, 2003
PubMed
Summary

For children with perianal abscess (PA), incision and drainage alone leads to high recurrence. Concomitant fistulotomy during primary drainage prevents recurrence, suggesting it should be standard care for pediatric PA.

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology

Background:

  • Perianal abscess (PA) is common in children.
  • Optimal primary treatment for pediatric PA remains uncertain.
  • Incision and drainage (I & D) alone has a high recurrence rate.

Purpose of the Study:

  • To identify causes of PA recurrence in children.
  • To assess the value of combining fistulotomy with primary I & D for PA.

Main Methods:

  • Retrospective review of 33 pediatric PA cases (1992-1997).
  • Cases were divided into I & D alone (13) versus I & D with fistulotomy (20).
  • Recurrence rates were compared between groups.

Main Results:

  • Overall recurrence rate was 21.2% (7/33).

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  • All recurrences occurred in the I & D alone group.
  • No recurrences were observed in the group treated with I & D plus fistulotomy.

    • Conclusions:

    • Primary I & D for pediatric PA is associated with significant recurrence.
    • Concomitant fistulotomy at the time of primary drainage effectively prevents recurrence.
    • Pediatric PA treatment should include a thorough search for and treatment of coexisting fistulas via fistulotomy.