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Fistula-in-ano in infancy and childhood
A H al-Salem1, W Laing, V Talwalker
1Department of Surgery, Qatif Central Hospital, Saudi Arabia.
Insights
Congenital fistula-in-ano (FIA) is suggested by early onset and specific epithelial lining in children. Perianal abscess (PA) and FIA show a causal link in boys.
Area of Science:
- Pediatric Surgery
- Pediatric Urology
- Gastroenterology
Background:
- Fistula-in-ano (FIA) and perianal abscess (PA) are common pediatric conditions.
- The etiology of FIA in children remains debated, with both congenital and acquired causes proposed.
- Understanding the relationship between PA and FIA is crucial for effective management.
Purpose of the Study:
- To investigate the clinical characteristics and potential etiology of FIA in a pediatric cohort.
- To explore the association between perianal abscess (PA) and fistula-in-ano (FIA) in male patients.
- To analyze histological findings of excised fistulae for etiological clues.
Main Methods:
- Retrospective study of 36 pediatric patients with FIA and/or PA over a 3-year period.
- Analysis of patient demographics, fistula onset, laterality, and multiplicity.
- Histological examination of excised fistulae from 16 patients undergoing fistulectomy.
Main Results:
- In 76.2% of 21 FIA patients, fistulae developed within the first two years of life.
- Histological examination revealed mixed epithelial linings (squamous, transitional, columnar) in excised FIA tracts.
- A causal relationship was observed between PA and FIA in male patients.
Conclusions:
- Early onset, high incidence of bilateral/multiple fistulae, and specific epithelial lining support a congenital etiology for pediatric FIA.
- The findings suggest a significant association between perianal abscess and fistula-in-ano in boys.
- These results aid in understanding the pathogenesis and guiding treatment strategies for pediatric perianal conditions.
Abstract:
The authors report the results of a retrospective study of 36 patients with fistula-in-ano (FIA) and/or perianal abscess (PA) presenting during a 3-year period. In 76.2% of the 21 patients with FIA, the fistulae developed in the first 2 years of life. For eight of the 16 patients who underwent fistulectomy, histological examination of the excised fistulae showed an epithelial lining of the tract mixed with stratified squamous, transitional and columnar epithelium. The early onset of FIA, the high percentage of bilateral and multiple fistulae, and the presence of these types of epithelium lining support a congenital etiology of FIA in children. In boys, a causal relationship exists between PA and FIA.