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Sun Y, Hao S, Zhang X, Liang H, Yao Y, Lu J, Wang C. A Systematic Review and Meta-Analysis of Comparing Drainage Alone versus Drainage with Primary Fistula Treatment for the Perianal Abscess in Children. Eur J Pediatr Surg 2024; 34:204-214. [PMID: 37023788 PMCID: PMC11076104 DOI: 10.1055/a-2070-3613] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
This systematic review and meta-analysis of nonrandomized studies (NRSs) aimed to evaluate the clinical efficacy and safety of two types of surgical interventions (respectively drainage alone and drainage with primary fistula treatment) for perianal abscesses (PAs) in children. Studies from 1992 to July 2022 were searched in 10 electronic databases. All relevant NRSs with available data which compared surgical drainage with or without primary fistula treatment were included. Patients with underlying diseases which led to abscess formation were excluded. The Newcastle-Ottawa Scale was used to assess the risk of bias and quality of the included studies. The outcomes were the healing rate, fistula formation rate, fecal incontinence, and wound healing duration. A total of 16 articles with 1,262 patients were considered suitable for the final meta-analysis. Primary fistula treatment was associated with a significantly higher healing rate when compared with incision and drainage alone (odds ratio [OR]: 5.76, 95% confidence interval [CI]: 4.04-8.22). This aggressive procedure for PA resulted in an 86% reduction in the fistula formation rate (OR: 0.14, 95% CI: 0.06-0.32). Limited data showed patients who underwent primary fistula treatment have a minor effect on postoperative fecal incontinence. Primary fistula treatment demonstrates a better clinical efficacy in promoting the healing rate and decreasing the formation of fistulas in PAs in children. The available evidence for a minor impact on anal function after this intervention is less strong.
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Affiliation(s)
- Yanting Sun
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
- Institute of Traditional Chinese Medicine Surgery, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Shuang Hao
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Xi Zhang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Hongtao Liang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Yibo Yao
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Jingen Lu
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Chen Wang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
- Institute of Traditional Chinese Medicine Surgery, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
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Ding C, Chen Y, Yan J, Wang K, Tan SS. Risk factors for therapy failure after incision and drainage alone for perianal abscesses in children. Front Pediatr 2024; 12:1342892. [PMID: 38390277 PMCID: PMC10881786 DOI: 10.3389/fped.2024.1342892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
Background It is well known that recurrent perianal abscesses (PAs) and fistula-in-ano (FIA) are the main causes of therapy failure following incision and drainage (I&D) for PAs. But few studies have focused on the risk factors for therapy failure after I&D for PAs in children. In this study, we retrospectively examine the risk factors for therapy failure after I&D for PAs in children in a pediatric tertiary care institution. Methods A retrospective review of all outpatient children with PA treated by I&D at Beijing Children's Hospital between January 2021 and December 2022 was performed. A follow-up was conducted in October 2023. Patients with other predisposing factors for perianal infection, such as inflammatory bowel disease, hematologic tumor, and anorectal surgery, were excluded from this study. Logistic regression yielding odds ratios (ORs) was used to assess the significance of variables for therapy failure. Results Of 160 children initially identified, follow-up was available for 146, with a total of 172 treatments. A total of 91% of children were male. The median (interquartile range) age at I&D was 2 (1, 15) months. The median follow-up duration was 20 (14, 25) months. Therapy failure occurred in 25 (15%) treatments performed for the prevention of recurrence of PA and in 35 (20%) treatments for the prevention of development of FIA. In the univariate analysis, a history of PA (P = 0.001), history of I&D (P = 0.014), and multilocal occurrence (P = 0.003) were associated with therapy failure. A sitz bath after I&D (P = 0.016) and regular cleaning of the wound after I&D (P = 0.024) were associated with therapy success. In the multivariate analysis, a history of PA (P = 0.015, OR = 3.374) and multilocal occurrence (P = 0.012, OR = 4.649) were independently associated with therapy failure. Regular cleaning of the wound (P = 0.017, OR = 0.341) and sitz bath (P = 0.001, OR = 0.128) after I&D were independently associated with therapy success. Conclusions A history of PA and multilocal occurrence were predictor factors for therapy failure before I&D. Regular cleaning of the wound and sitz bath after I&D were protective factors for therapy success. Therefore, regular cleaning of the wound and sitz bath after I&D should be emphasized in all children with PAs, especially in those with a history of PA and multilocal occurrence.
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Affiliation(s)
- CaiLin Ding
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - YaJun Chen
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - JiaYu Yan
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Kai Wang
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Sarah Siyin Tan
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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Yin W, Li Y, Zhang J, Jiao Y, Pei W, Xu X, Fan M, Xu J, Zhou Y, Wang S, Wei Y. Natural course of perianal abscess in infants: a real-world study. Sci Rep 2023; 13:18416. [PMID: 37891236 PMCID: PMC10611711 DOI: 10.1038/s41598-023-45751-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023] Open
Abstract
Natural course of perianal abscess (PA) in infancy remains obscure. This study aimed to investigate the natural course of infants with PA after conservative treatment. A retrospective cohort study was conducted in infants with PA who were treated conservatively (due to the parents' refusal of surgery), for more than 2 months between 2014 and 2020 at a single tertiary center. 153 patients (149 boys and 4 girls) were identified. The median follow-up was 5.3 years (range 3-8.2 years). Initially, 119 patients (77.8%) were completely cured by conservative treatment, and 34 (22.2%) failed. Among the 34 patients, 23 continued conservative treatment (20 cure, 3 fistula formation) and 11 underwent surgery. After conservative treatment, the rate of fistula formation, abscess recurrence, and new-onset abscess were 15.0%, 4.6%, and 6.5%, respectively. Overall, 139 patients (90.8%) were cured conservatively without surgery, and 11 (7.2%) underwent surgical management. In addition, 3 (2.0%) patients developed fistula-in-ano (under observation). PA in infants may be a time-limited and self-limited condition. Conservative management should be the first choice of treatment in most cases. Longer periods of conservative treatment may achieve better clinical outcomes in selected cases. There will be a percentage of patients (about 10%) that would require surgical treatment.
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Affiliation(s)
- Wanbin Yin
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Yansen Li
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Jingfeng Zhang
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Yang Jiao
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Wenju Pei
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Xiangjun Xu
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Mingfeng Fan
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Juan Xu
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Yue Zhou
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Shuai Wang
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China.
| | - Yanhua Wei
- Department of Infectious Diseases, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China.
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Guner Ozenen G, Akaslan Kara A, Ozer A, Kacar P, Ergun D, Aydin A, Genisol Ataman I, Polatdemir K, Payza AD, Sorguc Y, Oral A, Bayram N, Devrim I. Perianal abscess in children: an evaluation of microbiological etiology and the effectiveness of antibiotics. Pediatr Surg Int 2023; 39:272. [PMID: 37695379 DOI: 10.1007/s00383-023-05556-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE We aimed to evaluate the demographic characteristics of children with perianal abscess, distribution of microbiological etiology, antibiotic susceptibility, and identify the effectiveness and coverage of antibiotics due to culture results. METHODS A retrospective study was designed to evaluate pediatric patients with perianal abscesses between January 2013 and December 2022. RESULTS A total of 197 episodes in 135 patients were evaluated. The median age of the patients was 10 months (22 days-17 years). The isolated microorganisms were Gram-positive bacteria in 56 (28.4%) patients and Gram-negative bacteria in 141 (71.6%) patients. The most common isolated species was Escherichia coli (n = 70, 35.5%), followed by Klebsiella spp. (n = 48, 24.4%), Staphylococcus aureus (n = 37, 18.9%), and Enterobacter spp. (n = 9, 4.5%). Forthy-two percent (n = 58) of isolates were positive for extended-spectrum beta-lactamase, 8% (n = 11) were carbapenem-resistant in Gram-negative bacteria, and 37.5% (n = 21) were methicillin-resistant, 7.1% (n = 4) were vancomycin-resistant in Gram-positive bacteria. According to bacterial culture results, ertapenem plus glycopeptide had the highest antimicrobial coverage rate (92.3%), followed by ertapenem plus clindamycin (89.8%), ertapenem (81.7%), third-generation cephalosporin plus glycopeptide (82.2%), third-generation cephalosporin plus clindamycin (69.5%). CONCLUSION Ertapenem can be a good choice in the empirical treatment of perianal abscesses in children due to its high coverage rate.
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Affiliation(s)
- Gizem Guner Ozenen
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children's Hospital, Konak, Izmir, 35210, Turkey.
| | - Aybuke Akaslan Kara
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children's Hospital, Konak, Izmir, 35210, Turkey
| | - Arife Ozer
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children's Hospital, Konak, Izmir, 35210, Turkey
| | - Pelin Kacar
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children's Hospital, Konak, Izmir, 35210, Turkey
| | - Deniz Ergun
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children's Hospital, Konak, Izmir, 35210, Turkey
| | - Aysenur Aydin
- Department of Pediatrics, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Incinur Genisol Ataman
- Department of Pediatric Surgery, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Kamer Polatdemir
- Department of Pediatric Surgery, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Ayse Demet Payza
- Department of Pediatric Surgery, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Yelda Sorguc
- Department of Medical Microbiology, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Akgun Oral
- Department of Pediatric Surgery, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Nuri Bayram
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children's Hospital, Konak, Izmir, 35210, Turkey
| | - Ilker Devrim
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children's Hospital, Konak, Izmir, 35210, Turkey
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Lin CA, Chou CM, Huang SY, Chen HC. The optimal primary treatment for pediatric perianal abscess and anal fistula: A systemic review and meta-analysis. J Pediatr Surg 2023:S0022-3468(23)00091-X. [PMID: 36894443 DOI: 10.1016/j.jpedsurg.2023.01.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Perianal abscesses and anal fistulas are common. The principle of intention-to-treat has not been considered in previous systemic reviews. Thus, the comparison between primary and post-recurrence management was confused, and the recommendation of primary treatment is obscure. The current study aims to identify the optimal initial treatment for pediatric patients. METHODS Using PRISMA guidelines, studies were identified from MEDLINE, EMBASE, PubMed, Cochrane Library, and Google Scholar without any language or study design restriction. The inclusion criteria include original articles or articles with original data, studies of management for a perianal abscess with or without anal fistula, and patient age of <18 years. Patients with local malignancy, Crohn's disease, or other underlying predisposing conditions were excluded. Studies without analyzing recurrence, case series of <5, and irrelevant articles were excluded in the screening stage. Of the 124 screened articles, 14 articles had no full texts or detailed information. Articles written in a language other than English or Mandarin were translated by Google Translation first and confirmed with native speakers. After the eligibility process, studies that compared identified primary managements were then included in the qualitative synthesis. RESULTS Thirty-one studies involving 2507 pediatric patients met the inclusion criteria. The study design consisted of two prospective case series of 47 patients and retrospective cohort studies. No randomized control trials were identified. Meta-analyses for recurrence after initial management were performed with a random-effects model. Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615-2.427, p = 0.567). Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109-0.707, p = 0.007). Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761-10.792, p = 0.001). Subgroup analysis of different approaches within conservative treatment and operation was not performed for lacking information. CONCLUSION Strong recommendations cannot be made due to the lack of prospective or randomized controlled studies. However, the current study based on real primary management supports initial surgical intervention for pediatric patients with perianal abscesses and anal fistula to prevent recurrence. LEVEL OF EVIDENCE Type of study: Systemic review; Evidence level: Level II.
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Affiliation(s)
- Chih-An Lin
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Man Chou
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Sheng-Yang Huang
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
| | - Hou-Chuan Chen
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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Ding YW, Yin HQ, Liang HT, Lu JG, Wang B, Wang C. Can transcutaneous perianal ultrasonography be the first-line diagnostic instrument for evaluating pediatric perianal fistulas? Gastroenterol Rep (Oxf) 2022; 10:goac071. [PMID: 36457375 PMCID: PMC9707404 DOI: 10.1093/gastro/goac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/14/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pediatric perianal fistula is a common disorder. It is more difficult to detect the fistula tract and internal opening (IO) in children than in adults. This study aimed to evaluate the clinical diagnostic value of transcutaneous perianal ultrasound for children with perianal fistula. METHODS A retrospective review was conducted by analysing the preoperative transcutaneous perianal ultrasound and intraoperative exploration results of 203 consecutive patients who were <3 years old and diagnosed with perianal fistula. Analyses were conducted to evaluate the accuracy and consistency of utilizing the transcutaneous perianal ultrasound in the diagnosis of the complexity and location of the IO of perianal fistulas. RESULTS Compared with intraoperative exploration, the preoperative transcutaneous perianal ultrasonography has almost perfect agreement (Kappa = 0.881, P < 0.001) in the diagnosis of fistula tract complexity and IO with a sensitivity of 92% and a specificity of 97%. In addition, both intraoperative exploration and transcutaneous perianal ultrasound diagnosis showed high consistency in the identification of the IO of perianal fistulas (Quadrant I Kappa = 0.831, Quadrant II Kappa = 0.773, Quadrant III Kappa = 0.735, Quadrant IV Kappa = 0.802, all P < 0.01). The IOs were mainly distributed in Quadrants IV and II in both simple and complex fistulas. CONCLUSIONS Transcutaneous perianal ultrasound, as a non-invasive and simple imaging technique, showed high accuracy in the diagnosis and identification of the fistula classification and IO location. It could be considered a first-line diagnostic instrument for evaluating perianal fistulas among children.
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Affiliation(s)
| | | | - Hong-Tao Liang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Jin-Gen Lu
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Bo Wang
- Shanghai Shumiao Health Cloud Co. Ltd, Shanghai, P. R. China
| | - Chen Wang
- Corresponding author. Longhua Hospital affiliated to Shanghai University of TCM, No. 725 South Wanping Road, Shanghai 200032, P. R. China. Tel: +86-18917763340; Fax: +86-21-64698173;
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Kang C, Liu G, Zhang R, Chenk J, Yan C, Guo C. Intermediate-Term Evaluation of Initial Non-Surgical Management of Pediatric Perianal Abscess and Fistula-In-Ano. Surg Infect (Larchmt) 2022; 23:465-469. [PMID: 35647894 DOI: 10.1089/sur.2021.351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Non-surgical intervention has been proposed for the management of perianal abscess (PA) and fistula-in-ano (FIA), with potential benefits in terms of quality of life, wound healing, and functional outcome, although this strategy remains rare and controversial. Here, we aimed to compare the intermediate-term outcomes of non-surgical management with those of surgical incision and/or drainage. Patients and Methods: A study of pediatric patients with first-time PA and/or FIA was conducted retrospectively from January 2010 to December 2020. The patient population was stratified by surgical and non-surgical management. The clinical outcomes, including PA recurrence, FIA formation, and wound healing time, were compared between the surgical and non-surgical management groups. Results: A total of 457 patients managed for first-time PA and/or FIA were eligible for the current study. Of these patients, 169 (50.9%) patients received non-surgical intervention. There were no differences in terms of age, gender distribution, wound healing course, or abscess size between the two groups. Furthermore, no difference was noted between the two groups in terms of PA recurrence and/or FIA development rates and revisits for additional treatment. Conclusions: Although PA/FIA management is still controversial, non-surgical intervention exhibited promising outcomes for most cases of first-time PA/FIA, with fewer hospital admissions and surgical procedures and similar recurrence and fistula formation incidences. Immediate surgical intervention might be avoided because PA/FIA has a chance for spontaneous resolution in children.
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Affiliation(s)
- Cailong Kang
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China
| | - Guobin Liu
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China
| | - Rensen Zhang
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China
| | - Jingyu Chenk
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China.,Department of Ultrasound, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Chengwei Yan
- Department of Pediatric General Surgery, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Chunbao Guo
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R China.,Department of Ultrasound, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
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Mekonen Y. A Diagnostic Approach to a Rare Case of a Recto-Cutaneous Fistula Following Recurrent Perianal Abscess: A Case Report. OPEN ACCESS SURGERY 2022. [DOI: 10.2147/oas.s360182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Yin W, Li L, Su L, Wang S. Incision and Drainage With Primary Fistulotomy of Perianal Abscess Is Safe and Effective in Neonates: A Long-Term Follow-Up Study. Front Pediatr 2022; 10:862317. [PMID: 35601425 PMCID: PMC9120821 DOI: 10.3389/fped.2022.862317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Perianal abscess (PA) in neonates is poorly understood, and its management remains controversial. The aim of this study was to compare incision and drainage (ID) with or without primary fistulotomy in the management of neonatal first-time PA. METHODS A retrospective comparative study was conducted for neonates with first-time PA treated with incision and drainage with primary fistulotomy (IDF) vs. ID between 2008 and 2017. RESULTS In total, 138 patients (137 boys and 1 girl) were identified; 65 in the IDF group and 73 in the ID group. The median follow-up was 6.5 years (range 4-13 years). Baseline characteristics were similar between the 2 groups. The cure rate in the IDF group (98.5%, 64/65) was significantly higher than that in the ID group (80.8%, 59/73; p = 0.001). The rate of fistula formation in the IDF group (1.5%, 1/65) was significantly lower than that in the ID group (13.7%, 10/73; p = 0.01). The rate of abscess recurrence was not statistically different (p = 0.12), even though the IDF group (0%, 0/65) seemed to have a better outcome than the ID group (5.5%, 4/73). No fecal incontinence was observed in any of our patients. CONCLUSIONS First-time PA in neonates can be treated safely and effectively by the IDF or by ID alone. The former may be advantageous over the latter in terms of the rate of cure and fistula formation.
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Affiliation(s)
- Wanbin Yin
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Laian Li
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lin Su
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Shuai Wang
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, Jining, China
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10
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Deffaa OJ, Gosemann JH, Lacher M, Wagner R. Increased Incidence of Functional Constipation in Children with a History of Perianal Abscess-A Single-Center Retrospective Cohort Study. Eur J Pediatr Surg 2021; 31:76-79. [PMID: 32950031 DOI: 10.1055/s-0040-1716881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Functional constipation (FC) is a common gastrointestinal disorder affecting up to 30 % of children. Voluntary stool withholding (e.g., after painful defecation) with consecutive harder and larger stools can result in avoidance patterns. Perianal abscesses (PA) are associated with anal pain and painful stooling. We hypothesized that patients with PA have a higher incidence of subsequent FC compared with children without PA. MATERIALS AND METHODS Between January 2010 and December 2016, we retrospectively analyzed all infants (< 365 days of life) presenting at our institution with PA or unilateral inguinal hernia repair (IH; control group). We screened the clinical charts of these patients for outpatient or inpatient visits due to FC according to ROME IV criteria between 01/2010 and 10/2019. Statistical analysis was done using chi-squared test. RESULTS We included a total of 37 infants with PA and 118 with IH repair (controls). Mean age at presentation for PA was 3.7 ± 0.5 months compared with 4.2 ± 0.3 months at surgery for IH. In the PA group, 6/37 (16%) developed FC compared with 1/118 (1%) in the control group (p-value < 0.01). Patients with PA presented with FC at a mean age of 22.3 ± 4.6 months. Twenty-three of thirty-seven (62%) of PA patients underwent surgery. The development of FC in the PA group was independent of conservative versus surgical treatment (14 vs. 17%, p >0.05). CONCLUSION Our study suggests that PA is associated with an increased risk of FC during the further course. Prophylactic stool softening in patients with PA may be considered to prevent subsequent FC.
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Affiliation(s)
| | | | - Martin Lacher
- Department of Pediatric Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Richard Wagner
- Department of Pediatric Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
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11
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Ding W, Sun YR, Wu ZJ. Treatment of Perianal Abscess and Fistula in Infants and Young Children: From Basic Etiology to Clinical Features. Am Surg 2020; 87:927-932. [PMID: 33284051 DOI: 10.1177/0003134820954829] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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.
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Affiliation(s)
- Wei Ding
- North Sichuan Medical College, Nanchong, China
| | - Yao-Ran Sun
- North Sichuan Medical College, Nanchong, China
| | - Zhi-Jiu Wu
- Department of Anorectal, 117913The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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12
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Stokes R, Wanaguru D, Saadi A, Adams S. Management of perianal abscesses in infants without general anaesthesia: a systematic review of the literature. Pediatr Surg Int 2020; 36:1317-1325. [PMID: 32785778 DOI: 10.1007/s00383-020-04728-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Perianal abscesses are a common surgical presentation in infants. Historically, general anaesthesia (GA) has been used to facilitate incision and drainage, with or without exploration for a fistula-in-ano (FIA). This review aims to assess outcomes following management of perianal abscesses without GA in infants less than 24 months old. We aim to identify the success of management without GA. Using PRISMA guidelines, studies were identified from MEDLINE, EMBASE and PubMed. Studies including infants less than 24 months with perianal abscesses managed without GA were reviewed. The primary outcome was the number of patients requiring GA following initial management without GA. Secondary outcomes included rates of recurrent perianal abscesses, rates of progression to FIA and time to cure. Nine studies, involving 1049 infants less than 24 months old met inclusion criteria. A total of 1039 (99.0%) were males. Study design consisted of one prospective case series of 18 patients, and eight retrospective cohort studies. There were no randomized control trials. A total of 1037 (98.9%) patients were initially managed without GA. Of these, 59 (5.6%) were documented to subsequently require a general anaesthetic. Treatment modalities included antibiotics, regular baths, needle aspiration, incision and drainage under local anaesthesia, hainosankyuto and fibroblast growth factor. A total of 790 (75.3%) healed primarily without further intervention. A total of 243 (23.2%) were documented to have a recurrence or progression to FIA. All patients who required a subsequent general anaesthetic had progressed to FIA. Despite the lack of well-designed prospective studies, existing evidence supports management of perianal abscesses without initial GA in infants, with more than 75% healing completely. Further research aimed at standardizing care and confirming the safety and efficacy of initial non-operative management are warranted, and may potentially reduce the number of unnecessary initial and subsequent clinical interventions.
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Affiliation(s)
- R Stokes
- Department of Paediatric Surgery, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia.
| | - D Wanaguru
- Department of Paediatric Surgery, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia.,School of Women's and Children's Health, The University of New South Wales, Sydney, NSW, Australia
| | - A Saadi
- Department of Paediatric Surgery, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
| | - S Adams
- Department of Paediatric Surgery, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia.,School of Women's and Children's Health, The University of New South Wales, Sydney, NSW, Australia
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13
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Liu YH, Lv ZB, Liu JB, Sheng QF. Perianorectal abscesses and fistula due to ingested jujube pit in infant: Two case reports. World J Clin Cases 2020; 8:4930-4937. [PMID: 33195663 PMCID: PMC7642569 DOI: 10.12998/wjcc.v8.i20.4930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND About 90% of perianal infection is caused by cryptoglandular infection. Only a few cases of peritonitis or intra-abdominal abscesses secondary to perforation of the digestive tract by an ingested foreign body have been reported. The most common sites of impaction and perforation include the appendix, cecum and the terminal ileum. The rectum is an unusual site of foreign body impaction. This report intends to highlight that ingested foreign body impacted in the rectum is an extremely rare cause of perianal abscess and subsequent fistula in infants.
CASE SUMMARY Two cases of perianal abscess and fistula due to ingested jujube pit impacted in the rectum are reported. Both cases are infants with free previous medical history suffered from recurrent perianal infection. The caregivers of the two patients denied ingestion of a foreign body or any history of trauma. Physical examination combined with ultrasound or computed tomography scan established the diagnosis. Both of the patients underwent operation under general anesthesia. In case 1, a jujube pit with sharp ends was discovered embedded within a subcutaneous fistula. The jujube pit was then removed intact along with fistula resection. The wound was successfully laid open to allow healing by secondary intention. In case 2, a jujube pit was found with its sharp end puncturing the rectum, surrounded by pus and necrotic tissue. Subsequent incision and adequate drainage were performed. The whole jujube pit was then removed from the abscess cavity at the same time. Both patients received colonoscopy to rule out inflammatory bowel disease or other potential damages by the ingested jujube pit. The postoperative period was uneventful. At 1.5 year follow-up, no recurrent abscess or fistula were found in either patient.
CONCLUSION An impacted foreign body must not be overlooked as an unusual cause of perianal abscess and fistula, especially in young children.
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Affiliation(s)
- Ying-Hua Liu
- Department of General Surgery, Children’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200333, China
| | - Zhi-Bao Lv
- Department of General Surgery, Children’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200333, China
| | - Jiang-Bin Liu
- Department of General Surgery, Children’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200333, China
| | - Qing-Feng Sheng
- Department of General Surgery, Children’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200333, China
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14
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Erol T, Mentes B, Bayri H, Osmanov I, Leventoglu S, Yildiz A, Yorubulut M, Sungurtekin U. Preventing the recurrence of acute anorectal abscesses utilizing a loose seton: a pilot study. Pan Afr Med J 2020; 35:18. [PMID: 32341739 PMCID: PMC7170736 DOI: 10.11604/pamj.2020.35.18.21029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/10/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction This pilot study aimed to document our results of treating anorectal abscesses with drainage plus loose seton for possible coexisting high fistulas or drainage plus fistulotomy for low tracts at the same operation. Methods Drainage plus fistulotomy were performed only in cases with subcutaneous mucosa, intersphincteric, or apparently low transsphincteric fistula tracts. For all other cases with high transsphincteric fistula or those with questionable sphincter involvement, a loose seton was placed through the tract. Drainage only was carried out in 17 patients. Results Twenty-three patients underwent drainage plus loose seton. Drainage plus fistulotomy were performed in four cases. None of the patients developed recurrent abscess during a follow-up of 12 months. Not surprisingly, the incontinence scores were similar pre and post-operatively (p=0.564). Only minor complications occurred in 4 cases (14.8 percent). Secondary interventions following loose seton were carried out in 13 patients (48.1 percent). At 12 months, drainage only was followed by 10 recurrences (58.8 percent; p<0.0001, compared with concomitant surgery). Conclusion Concomitant loose seton treatment of high fistula tracts associated with anorectal abscess prevents abscess recurrence without significant complications or disturbance of continence. Concomitant fistulotomy for associated low fistulas also aids in the same clinical outcome. Concomitant fistula treatment with the loose seton may suffice in treating the whole disease process in selected cases. Even in patients with high fistula tracts, the loose seton makes fistula surgery simpler with a mature tract. Abscess recurrence is high after drainage only.
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Affiliation(s)
- Timucin Erol
- Department of Surgery/Proctology, Memorial Ankara Hospital, Ankara, Turkey
| | - Bulent Mentes
- Department of Surgery/Proctology, Memorial Ankara Hospital, Ankara, Turkey
| | - Hakan Bayri
- Department of Surgery/Proctology, Memorial Ankara Hospital, Ankara, Turkey
| | - Igbal Osmanov
- Department of Surgery/Proctology, Memorial Ankara Hospital, Ankara, Turkey
| | - Sezai Leventoglu
- Department of Surgery, Gazi University Medical School, Ankara, Turkey
| | - Alp Yildiz
- Department of Surgery, Yildirim Beyazit University, Yenimahalle Research and Training Hospital, Ankara, Turkey
| | | | - Ugur Sungurtekin
- Department of Surgery, Pamukkale University Medical School, Denizli, Turkey
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15
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Samuk I, Avinadav E, Barak U, Seguier E, Steiner Z, Freud E. Perianal abscess in infants: Amenable to conservative treatment in selected cases. Pediatr Int 2019; 61:1146-1150. [PMID: 31469939 DOI: 10.1111/ped.13996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/04/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Perianal abscess is a common surgical condition in daily pediatric practice. Management is a subject of controversy and a variety of approaches are practiced. While the most frequent approach is drainage with/without fistulotomy, the superiority of this approach and the place of conservative approach has not been established. The aim of this study was to evaluate the outcomes of conservative approach in selected cases of perianal abscesses in infants. METHODS Data of 19 patients aged <24 months treated conservatively for perianal abscess at a tertiary hospital in 2014-2018 were retrospectively reviewed. RESULTS Criteria for a conservative approach were: spontaneous drainage into the anal canal (n = 8) or perianal skin (n = 4), and phlegmonous infiltrate with fluid collection detected on ultrasound (n = 7). Mean age at symptom onset was 8.4 months. Twelve patients were managed for the first time. Previous care in seven patients included 1-4 drainage procedures (n = 4), spontaneous drainage (n = 1) and antibiotics (n = 2). Five patients were on oral antibiotics at presentation. After diagnosis, 18 patients received i.v. antibiotics and one, oral antibiotics. Three patients (15.7%) ultimately required surgical drainage; two were lost to follow up. During follow up (mean, 22.4 months) four patients (28.5%) had a single recurrent episode; abscess in three (managed conservatively in two and surgically in one) and fistula-in-ano in one patient that healed spontaneously. Thus, surgical intervention was prevented in 13/17 patients (76.4%) available for follow up. CONCLUSIONS Perianal abscess in infants is amenable to conservative management in selected cases. Avoiding surgical intervention is advantageous, especially given the high recurrence rate.
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Affiliation(s)
- Inbal Samuk
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Avinadav
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Barak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of, Anesthesia, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Emmanuelle Seguier
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvika Steiner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Surgery, Meir Medical Center, Kfar Sava, Israel
| | - Enrique Freud
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Barry WE, Asuelime GE, Zhou S, Hammoudeh J, Ford HR, Kim ES. Congenital Perirectal Dermoid Cyst: A Rare Cause of Complex, Recurrent Pediatric Fistula-in-ano. Front Pediatr 2018; 6:143. [PMID: 29868530 PMCID: PMC5964207 DOI: 10.3389/fped.2018.00143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/30/2018] [Indexed: 11/13/2022] Open
Abstract
Perianal abscess and fistula-in-ano are well-described in the pediatric population. They are most common in infants less than 1 year of age and often resolve with oral antibiotics; occasionally they require drainage or fistulotomy. The etiology is commonly associated with cryptoglandular obstruction and subsequent infection, however alternative diagnoses should be considered in cases of recurrent abscesses and fistulae that are refractory to standard treatments. In this report, we present the case of an 8-year-old boy with a complex, recurrent fistula-in-ano that resulted from a rare congenital perirectal dermoid cyst.
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Affiliation(s)
- Wesley E Barry
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Grace E Asuelime
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Shengmei Zhou
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Jeffrey Hammoudeh
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.,Division of Plastic Surgery, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Henri R Ford
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Eugene S Kim
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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17
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Perianale Abszesse und Fisteln im Säuglings- und Kleinkindalter. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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