Treatment of Perianal Abscess and Fistula in Infants and Young Children: From Basic Etiology to Clinical Features

Abstract

Perianal abscess and anal fistula are 2 common anorectal diseases in infants and young children. However, their causes, clinical diagnosis, and treatment remain controversial. Compared to adults, infants with these 2 diseases exhibit unique clinical characteristics. Blind pursuit of conservative treatment or surgery may worsen the condition, resulting in increased pain in young patients and greater economic burden and psychological harm to parents. Therefore, it is crucial to select correct and effective treatments. This review summarizes the relevant literature from the past 10 years and systematically explains the pathogenesis, clinical characteristics, and treatment measures of perianal abscess and anal fistula in infants with the goal of providing clinicians a deeper understanding of perianal abscess and anal fistula in infants and summarizing safe and effective treatment methods.

Incision and Drainage With Primary Fistulotomy of Perianal Abscess Is Safe and Effective in Neonates: A Long-Term Follow-Up Study

“…It has traditionally been treated surgically by incision and drainage (ID) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, in the past two decades, some studies have shown that the conservative management appears to be effective in selected cases (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). On the other hand, the other studies have recommended that the surgical procedure should involve a careful identification for the fistula and treatment of that by fistulotomy (24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Risk Factors for Treatment Failure in Neonates With Skin and Soft Tissue Infection: A Retrospective Cohort Study

“…Currently, the treatment of perirectal fistulas is often based on surgeon preference given the lack of consensus among pediatric surgeons on the optimal treatment preference given the lack of consensus among pediatric surgeons on the optimal treatment because of studies describing variable effectiveness between conservative and surgical management against recurrence. [20][21][22][23][24] Further studies, preferably randomized controlled trials, are needed to determine if using antibiotics with gram-negative coverage for polymicrobial organisms found in perirectal SSTIs reduces rates of treatment failure in neonates with perirectal SSTIs or if other modes of management, such as surgery consultation, may be useful in the index admission to reduce readmissions and ED revisits.…”

Incidence and diagnostic performance of ultrasound for perianal abscess or fistula‐in‐ano in pediatric patients with perianal inflammation

“…Perianal inflammation, including perianal abscess and fistula‐in‐ano, is a common complication in children resulting from cryptitis‐caused bacterial entrapment at a thickened dentate line; further, it can progress to perianal abscess with or without healing and develop into a fistula‐in‐ano 1–6 . Physical examination as well as imaging examinations such as ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) can be used to detect and diagnose perianal abscess and fistula‐in‐ano 2–6 . Among these examinations, ultrasound allows the evaluation of pediatric patients since it can be rapidly performed at the patient's bedside without sedation or radiation exposure.…”