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Perianal abscess and fistula-in-ano in infants: a different entity?

Francis Serour1, Eli Somekh, Arkadi Gorenstein

  • 1Department of Pediatric Surgery, The Edith Wolfson Medical Center, Halokhamim Street 62, 58100 Holon, Israel. serour@wolfson.health.gov.it

Diseases of the Colon and Rectum
|December 24, 2004
PubMed

Insights

Perianal abscess and fistula-in-ano in infants require tailored management. Needle aspiration for abscess drainage and conservative treatment for fistula-in-ano, with antibiotics potentially reducing fistula development, are effective strategies.

Area of Science:

  • Pediatric Surgery
  • Pediatric Urology

Background:

  • Infantile perianal abscess and fistula-in-ano present unique clinical features.
  • Treatment strategies for these conditions in infants remain a subject of debate.

Purpose of the Study:

  • To evaluate the effectiveness of different management approaches for perianal abscess and fistula-in-ano in infants.
  • To compare treatment outcomes in infants younger than 24 months.

Main Methods:

  • Retrospective analysis of 98 infants (under 24 months) treated for perianal abscess and/or fistula-in-ano between 1990 and 2002.
  • Review of drainage methods (needle aspiration, incision and drainage), antibiotic use, and local care.
  • Analysis of fistula development and treatment outcomes.

Main Results:

  • Perianal abscess occurred in 77 infants (75 male); fistula-in-ano in 21 (all male).
  • Antibiotic use post-drainage reduced fistula development (27.9% vs. 66.7%, P < 0.05).
  • Spontaneous fistula cure occurred in 42.9%; 57.1% required fistulectomy, often with cryptotomy, showing no recurrence.

Conclusions:

  • Early local treatment and needle aspiration for perianal abscess are effective in infants.
  • Antibiotics may be beneficial post-drainage to prevent fistula formation.
  • Conservative management of fistula-in-ano for 1-3 months is recommended, followed by fistulectomy with cryptotomy for persistent cases.
Abstract

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