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Perianal abscess and fistula in ano in infancy and childhood: a clinicopathological study
A H al-Salem1, S Qaisaruddin, S S Qureshi
1Department of Surgery, Qatif Central Hospital, Saudi Arabia.
Insights
In children, perianal abscesses in males often lead to fistula in ano, while females typically recover without developing fistulas. Gut bacteria are frequently implicated in male perianal abscesses.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Pediatric Gastroenterology
Background:
- Perianal abscess and fistula in ano are common pediatric surgical conditions.
- Understanding the relationship between these conditions and their demographic associations is crucial for effective management.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of pediatric perianal abscess and fistula in ano.
- To explore potential causal links between perianal abscess and the development of fistula in ano in children.
Main Methods:
- Retrospective chart review of 78 children diagnosed with perianal abscess and/or fistula in ano over 6.5 years.
- Analysis of patient demographics, clinical presentation, microbiological findings, and treatment outcomes.
- Correlation of initial presentation with subsequent development of fistula in ano.
Main Results:
- A total of 78 children (65 males, 13 females) were studied, with a median age of 1.7 years.
- All females presented with perianal abscess (Staphylococcus aureus common), with no fistula development. Males showed higher rates of initial fistula presentation and subsequent fistula development after abscess.
- Fistula in ano occurred exclusively in males (40 cases), with a significant isolation of gut-derived organisms (88.4%) from perianal abscesses.
Conclusions:
- Perianal abscess in male children has a significant association with the subsequent development of fistula in ano.
- Fistula in ano in this pediatric cohort appears to be a direct sequela of perianal abscess, particularly in males.
- Gender-specific differences in presentation and progression highlight the need for tailored diagnostic and management approaches.
Abstract:
This is a retrospective study of 78 children with perianal abscess and/or fistula in ano presenting during a 6 1/2-year period. Sixty-five were males and 13 females. Their ages at presentation ranged from 22 days to 18 years (median 1.7 year), and the majority of males were below 2 years of age. The 13 females all presented with perianal abscess, the majority of which grew Staphylococcus aureus (69.2%). On follow-up, none of them developed fistula in ano. Twenty-two of the 65 males (33.8%) presented initially with fistula in ano. The remaining 43 presented with perianal abscess. Four of them were found to have fistula in ano at the time of incision and drainage and on follow-up, and 14 others developed fistula in ano. Of the 40 cases of fistula in ano, all were males; 25 were on the right side and 9 on the left side, 5 had bilateral fistula in ano, and 1 had two fistulas on the left side at 3 and 5 o'clock positions. Gut-derived organisms were isolated from 88.4% of the males with perianal abscess. There appears to be a causal relationship between perianal abscess and fistula in ano.