RSS-Feed abonnieren
DOI: 10.1055/s-0029-1241878
© Georg Thieme Verlag KG Stuttgart · New York
Management of Perianal Abscess and Fistula-in-ano in Children
Publikationsverlauf
received August 12, 2009
accepted after revision September 23, 2009
Publikationsdatum:
06. November 2009 (online)
Abstract
Introduction: Perianal abscess (PA) and fistula-in-ano (FIA) are common acquired anorectal disorders in children, but their management is still controversial. This study was performed to evaluate our experience with the treatment of PA and FIA in children of different age groups.
Material and Methods: A retrospective study was conducted of children below 16 years of age treated for PA/FIA in a pediatric surgery center between January 2002 and April 2006. The standard treatment for PA was incision and drainage (I&D). Judicious probing for fistulae was only performed in recurrent abscess or if a discharge of pus was identified from the anal verge at surgery. Fistulotomy was routinely performed in low fistulae not associated with inflammatory bowel disease (IBD). IBD associated fistulae were treated with topical tacrolimus in the absence of deep seated infection. Patients were divided into 3 age groups: <2 years, 2–8 years and >8 years. Mode of treatment, microbial organisms, recurrence, associated FIA and association with IBD were recorded. The median follow-up period was 6 months (8 weeks–3 years). Fisher's exact test was used for the analysis of categorical variables.
Results: A total of 78 (39 [<2 years]; 17 [2–8 years]; 22 [>8 years]) patients were treated for PA/FIA during the four year period. In children aged <2 years, 33 (85%) had I&D of PA and the other 6 (15%) had fistulotomy. Recurrence was seen in 9 (23%) children, of which 3 (8%) had FIA. In children aged 2–8 years, 13 (76%) had PA and 4 (24%) had a FIA and there were no recurrences. In children >8 years, 12 (55%) had I&D, 1 (4%) had a fistulotomy and 9 (41%) were treated non-surgically. Six of 7 patients with IBD associated FIA were treated successfully with topical tacrolimus. The recurrence rate after primary surgery was significantly higher for <2 years and >8 years age groups compared to the 2–8 years age group. The incidence of FIA identified either at primary operation or during exploration for recurrence was highest (50%) in >8 years age group and lowest (21%) in the <2 years age group. Lactose fermenting coliforms were the most common organisms isolated from pus. The presence of intestinal organisms in pus was associated with significantly higher recurrence rates in children aged <2 years.
Conclusions: Surgery for PA/FIA in children aged <2 years resulted in low recurrence rates and should be considered as the primary treatment. Topical tacrolimus was found to be an effective treatment for IBD associated FIA.
Key words
abscess - rectal fistula - retrospective studies - child - tacrolimus
References
- 1 Piazza DJ, Radhakrishnan J. Perianal abscess and fistula-in-ano in children. Dis Colon Rectum. 1990; 33 1014-1016
- 2 Al-Wattar KM. Perianal sinuses in neonates and infants. Saudi Med J. 2002; 23 1499-1503
- 3 Murthi GV, Okoye BO, Spicer RD. et al . Perianal abscess in childhood. Pediatr Surg Int. 2002; 18 689-691
- 4 Christison-Lagay ER, Hall JF, Wales PW. et al . Nonoperative management of perianal abscess in infants is associated with decreased risk for fistula formation. Pediatrics. 2007; 120 e548-552
- 5 Rosen NG, Gibbs DL, Soffer SZ. et al . The nonoperative management of fistula-in-ano. J Pediatr Surg. 2000; 35 938-939
- 6 Watanabe Y, Todani T, Yamamoto S. Conservative management of fistula in ano in infants. Pediatr Surg Int. 1998; 13 274-276
- 7 al-Salem AH, Qaisaruddin S, Qureshi SS. Perianal abscess and fistula in ano in infancy and childhood: A clinicopathological study. Pediatr Pathol Lab Med. 1996; 16 755-764
- 8 Poenaru D, Yazbeck S. Anal fistula in infants: Etiology, features, management. J Pediatr Surg. 1993; 28 1194-1195
- 9 Abercrombie JF, George BD. Perianal abscess in children. Ann R Coll Surg Engl. 1992; 74 385-386
- 10 Duhamel J, Ngo Quang B. Particularities of anal fistula in children (40 cases). Arch Fr Pediatr. 1970; 27 743-752
- 11 Festen C, van Harten H. Perianal abscess and fistula-in-ano in infants. J Pediatr Surg. 1998; 33 711-713
- 12 Ho YH, Tan M, Chui CH. et al . Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses. Dis Colon Rectum. 1997; 40 1435-1438
- 13 Meyer T, Weininger M, Hocht B. Perianal abscess and anal fistula in infancy and childhood. A congenital etiology?. Chirurg. 2006; 77 1027-1032
- 14 al-Salem AH, Laing W, Talwalker V. Fistula-in-ano in infancy and childhood. J Pediatr Surg. 1994; 29 436-438
- 15 Barthes-Anidjar L, Wolter M, Bodemer C. et al . Perianal abcess in infant. Ann Dermatol Venereol. 2003; 130 357-360
- 16 Fitzgerald RJ, Harding B, Ryan W. Fistula-in-ano in childhood: a congenital etiology. J Pediatr Surg. 1985; 20 80-81
- 17 Longo WE, Touloukian RJ, Seashore JN. Fistula in ano in infants and children: Implications and management. Pediatrics. 1991; 87 737-739
- 18 Macdonald A, Wilson-Storey D, Munro F. Treatment of perianal abscess and fistula-in-ano in children. Br J Surg. 2003; 90 220-221
- 19 Oh JT, Han A, Han SJ. et al . Fistula-in-ano in infants: Is nonoperative management effective?. J Pediatr Surg. 2001; 36 1367-1369
- 20 Serour F, Gorenstein A. Characteristics of perianal abscess and fistula-in-ano in healthy children. World J Surg. 2006; 30 467-472
- 21 Hart AL, Plamondon S, Kamm MA. Topical tacrolimus in the treatment of perianal Crohn's disease: Exploratory randomized controlled trial. Inflamm Bowel Dis. 2007; 13 245-253
- 22 Nix P, Stringer MD. Perianal sepsis in children. Br J Surg. 1997; 84 819-821
Correspondence
Anindya Niyogi
Chelsea and Westminster Hospital
Paediatric Surgery
369 Fulham Road
SW10 9TQ London
United Kingdom
Telefon: +44 77 85962158
Fax: +44 20 87468644
eMail: a_niyogi@yahoo.com