Surgically Treated Perianal Abscess in Children: Clinical Characteristics and Subsequent Diagnosis of Crohn's Disease

To characterize clinical features and evaluate the proportion of children presenting with perianal abscess who were subsequently diagnosed with inflammatory bowel disease (IBD), and to explore factors associated with later Crohn's disease (CD) diagnosis. A retrospective cohort study was conducted including patients aged 3-18 years who underwent surgical drainage of perianal abscess between 2005 and 2025 at a tertiary pediatric center. Patients with a prior diagnosis of IBD or with clinically established perianal fistula at presentation were excluded. Clinical, laboratory, surgical, and follow-up data were analyzed. Anemia was defined according to age-adjusted World Health Organization thresholds, and hypoalbuminemia as serum albumin < 3.5 g/dL. A total of 204 children were included (median age at presentation: 10.9 years [IQR 7.9], 80.4% male). During a median follow-up of 41 months (IQR 28), 14 patients (6.8%) were subsequently diagnosed with CD. The median interval from abscess presentation to CD diagnosis was 7 months (IQR 12). At initial presentation, patients later diagnosed with CD were older (median age 13.45 vs. 10.65 years, p = 0.018) and had a higher rate of abscess recurrence (57.1% vs. 20.0%, p = 0.001). They also more frequently exhibited clinical features suggestive of IBD (71.4% vs. 18.4%, p = 0.0003), along with lower hemoglobin and albumin levels. Conclusion:In this single-center cohort of children undergoing surgical drainage of perianal abscess, Crohn's disease was diagnosed in a minority of patients. Clinical features such as anemia, growth-related concerns, and lower albumin levels were more common among those subsequently diagnosed with CD. These findings may help identify children who warrant closer follow-up and consideration of gastroenterological evaluation, although prospective studies are required to validate their predictive value.