Related Experiment Videos
Perianal abscess and fistula-in-ano in children
1Lutheran General Hospital, Park Ridge, Illinois.
Insights
Pediatric perianal abscesses and fistulas are more common in young males. Surgical treatment involving fistula identification and drainage is effective, with recurrences mainly in immunocompromised children.
Area of Science:
- Pediatric surgery
- Colorectal surgery
- Pediatric gastroenterology
Background:
- Perianal abscess and fistula-in-ano are common pediatric surgical conditions.
- Infants, particularly males, represent a distinct clinical group with higher recurrence rates after initial drainage.
- Fistula identification at surgery is crucial for effective management.
Purpose of the Study:
- To review pediatric perianal abscess and fistula-in-ano cases.
- To compare clinical presentation and outcomes between infants and older children.
- To evaluate the effectiveness of surgical management for these conditions.
Main Methods:
- Retrospective review of 40 pediatric patients.
- Clinical data analysis based on age groups (infants <2 years vs. children >2 years).
- Surgical intervention included examination under anesthesia, abscess saucerization, fistulotomy, and cryptotomy.
Main Results:
- 22 infants (<2 years) were all males; 10 had recurrent abscesses. 85.7% of infants with abscesses had fistulas.
- 18 children (>2 years) included 7 females and 11 males; 54.8% of those with abscesses had fistulas.
- Recurrences were observed only in two immunocompromised patients following surgical treatment.
Conclusions:
- Age and sex are significant factors in pediatric perianal abscess and fistula presentation.
- Surgical management focusing on fistula identification and treatment is effective in preventing recurrence.
- Immunocompromised status is a key risk factor for recurrent perianal abscess and fistula-in-ano in children.
Abstract:
The authors present a retrospective review of 40 pediatric patients with perianal abscess and/or fistula-in-ano. The total patient population could be divided clinically into 2 broad groups. The first group consisted of 22 infants younger than 2 years of age, all of whom were males, and 10 of whom presented with recurrences after previous incision and drainage. Of the 14 infants presenting with an abscess, in 12 (85.7 percent), a fistula-in-ano was discovered at surgery. In contrast, in the group of 18 children older than 2 years of age, there were 7 females and 11 males, and fistulas were identified in only 7 of 13 patients (54.8 percent) who presented with abscesses. Surgical treatment consisted of examination under anesthesia and a diligent search for a fistulous tract. Abscesses were primarily saucerized and fistulotomy and cryptotomy of the confluent crypt was performed if a fistulous tract was identified. The only recurrences with this form of treatment occurred in the two immunocompromised patients.