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Anal fistula in infants: etiology, features, management
1Division of Pediatric General Surgery, Hôpital Sainte-Justine, Montreal, Quebec, Canada.
Insights
Infantile anal fistulas, primarily affecting males, often stem from congenital anal crypt abnormalities. Surgical treatment, including fistulotomy or fistulectomy, showed no recurrence in this study.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Anorectal Diseases
Background:
- Anal fistulas in infants are poorly understood, with congenital anal crypt abnormalities suspected as a cause of recurrence.
- Infantile anal fistulas predominantly affect males and are frequently preceded by anorectal abscesses.
Purpose of the Study:
- To investigate the hypothesis that congenital abnormalities of the anal crypts are the cause of infantile anal fistulas.
- To review the management and outcomes of anal fistulas in children under two years of age.
Main Methods:
- Retrospective review of anal fistulas treated in children under 2 years old between 1980 and 1991.
- Analysis of patient demographics, clinical presentation, surgical procedures (fistulotomy, fistulectomy, cryptotomy), and follow-up data.
Main Results:
- The study included male infants with a mean age of 9.5 months; 92% had prior anorectal abscesses.
- Abnormal deep, thick-walled anal crypts were identified in 47% of cases.
- Surgical management resulted in no observed recurrences or fistula-related complaints during a mean follow-up of 20 months.
Conclusions:
- Infantile anal fistulas are strongly associated with abnormal anal crypts.
- Surgical interventions like fistulotomy or fistulectomy are effective in treating infantile anal fistulas without recurrence.
- While anorectal abscesses often precede fistula formation, not all abscesses lead to fistulas.
Abstract:
Anal fistulas in infants are poorly understood. A high incidence of recurrence has been attributed to a congenital abnormality of the anal crypts. To verify this hypothesis, we reviewed all anal fistulas seen in children less than 2 years of age and treated between 1980 and 1991. All patients were males with a mean age of 9.5 months, and only 3 had other illnesses. Ninety-two percent have had previous anorectal abscesses. The fistulas were single in 31 patients and double in 5. Their origin in the crypts was clearly identified in 14 cases. When anoscopy was routinely performed, deep thick-walled crypts were found in 47% of the cases. In most instances only one crypt was abnormal. The operative management included fistulotomy in 17 patients and fistulectomy in 9. Cryptotomies besides fistula excision were performed in 9 cases, and concurrent abscess drainage in 6. Follow-up was available in 31 patients for a mean length of 20 months. There were 4 complications (11%): one abscess requiring drainage, one wound infection treated conservatively, one granuloma, and one postoperative laryngitis. No recurrences were observed and none of the patients had fistula-related complaints at the last visit. Anal fistulas in infants are observed exclusively in males and are often related to abnormal crypts. Although 92% of fistulas are preceded by a perianal abscess, only 42% of perianal abscesses will result in fistula formation. Anal fistulas can be treated by either fistulotomy or fistulectomy.(ABSTRACT TRUNCATED AT 250 WORDS)