The nonoperative management of fistula-in-ano☆
Section snippets
Materials and methods
A prospective conservative approach to perianal abscess and fistula was undertaken in 18 infants presenting between 1990 and 1999. Abscesses were incised and drained and antibiotics administered only if the baby was very uncomfortable or had septic manifestations. Once a fistula was established we continued expectant management with follow-up at 3-month intervals until the fistula disappeared. We explained to parents that fistulotomy could be performed at any time if the fistula provoked pain
Results
All patients in this series were boys. The mean age at onset of symptoms was 4.2 ± 2.8 months (range, 0.3 to 9.7 months). Four patients had abscesses incised and drained under local anesthesia for discomfort (n = 3) or fever (n = 1). The remaining 14 patients' abscesses drained spontaneously. Two patients received courses of oral antibiotics before our surgical evaluation after which no patient received antibiotic therapy.
Fistulas developed in 14 patients (77%). All patients had complete
Discussion
Perianal abscesses and fistulas in neonates are different conditions than those found in older children. The male preponderance of these conditions as seen in the current series, has been well described.4 Older children presenting with perianal abscesses or fistulas tend to have a higher incidence of underlying conditions such as inflammatory bowel disease or leukemia.5, 6 Fistula-in-ano in an otherwise healthy neonate is suspected to originate as anal cryptitis, which progresses to form a
References (9)
- et al.
Perianal abscess and fistula-in-ano in infants
J Pediatr Surg
(1998) - et al.
Anal fistula in infants: Etiology, features, management
J Pediatr Surg
(1993) - et al.
Abnormal crypts of morgagni: The cause of perianal abscess and fistula-in-ano
J Pediatr Surg
(1987) - et al.
Fistula-in-ano in childhood: A congenital etiology
J Pediatr Surg
(1985)
Cited by (76)
James Warden and the Global Alliance Partnership: A Pediatric Surgery Giant and His Enduring PAPS Landmark
2024, Journal of Pediatric SurgeryThe Optimal Primary Treatment for Pediatric Perianal Abscess and Anal Fistula: A Systemic Review and Meta-Analysis
2023, Journal of Pediatric SurgeryBenign anorectal disease in children: What do we know?
2022, Archives de PediatrieCitation Excerpt :These procedures are accompanied by a recurrence rate of up to 68% in the pediatric population [36, 47]. Antibiotic usage for PA and fistula is controversial, with many studies characterizing them as beneficial and others reporting their application as ineffective in eradicating fistulas and preventing recurrences [36–38, 47]. Other efficacious surgical techniques less widely described in children are fibrin glue injection, anal fistula plug, defined as insertion of golf tee-shaped porcine collagen matrix in the fistula tract leading to closure, and video-assisted anal fistula treatment during which fistuloscopy and electrocoagulation with mucosal sleeve closure or the internal opening are performed [50–52].
Perianal abscess in children: A pediatric infectious disease perspective
2019, Anales de PediatriaRisk factors for therapy failure after incision and drainage alone for perianal abscesses in children
2024, Frontiers in PediatricsNatural course of perianal abscess in infants: a real-world study
2023, Scientific Reports
- ☆
Address reprint requests to Alberto Peña, MD, Chief, Division of Pediatric Surgery, CH-158, Schneider Children's Hospital, 269-01 76th Ave, New Hyde Park, NY 11040.