Download PDF
Eur J Pediatr Surg 2020; 30(05): 386-390
DOI: 10.1055/s-0040-1716726
Review Article

Perianal Abscesses and Fistulas in Infants and Children

Jan-Hendrik Gosemann
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
Martin Lacher
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Perianal abscess (PA) and fistula-in-ano (FIA) are common entities in infancy. Although several hypotheses have been suggested, the pathogenesis of PA/FIA remains elusive. The natural course of these diseases in infancy is self-limiting in the majority of cases whereas older children show similarities to PA/FIA in adults. It is important to rule out rare differential diagnoses of PA/FIA such as inflammatory bowel disease (IBD), surgical complications after colorectal surgery, and immunodeficiencies. Treatment remains empiric, comprises conservative, as well as surgical approaches, and is dependent on the age of the patient. This review summarizes anatomical aspects, current evidence on disease pathogenesis, clinical presentation, and management of pediatric patients with PA and FIA.

Keywords

perianal abscess - fistula-in-ano - children - conservative treatment - fistulotomy


Publication History

Received: 01 August 2020

Accepted: 16 August 2020

Article published online:
28 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 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 (03) e548-e552
    CrossrefPubMedGoogle Scholar
  • 2 Peña A, Bischoff A. Surgical Treatment of Colorectal Problems in Children. Cincinnati, OH: Springer International Publishing; 2015
    CrossrefGoogle Scholar
  • 3 Charalampopoulos A, Zavras N, Kapetanakis EI. , et al. Surgical treatment of perianal abscess and fistula-in-ano in childhood, with emphasis in children older than 2 years. J Pediatr Surg 2012; 47 (11) 2096-2100
    CrossrefPubMedGoogle Scholar
  • 4 Niyogi A, Agarwal T, Broadhurst J, Abel RM. Management of perianal abscess and fistula-in-ano in children. Eur J Pediatr Surg 2010; 20 (01) 35-39
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Meyer T, Weininger M, Höcht B. [Perianal abscess and anal fistula in infancy and childhood. A congenital etiology?] (in German) Chirurg. 2006; 77 (11) 1027-1032
    PubMedGoogle Scholar
  • 6 Poenaru D, Yazbeck S. Anal fistula in infants: etiology, features, management. J Pediatr Surg 1993; 28 (09) 1194-1195
    CrossrefPubMedGoogle Scholar
  • 7 Shafer AD, McGlone TP, Flanagan RA. Abnormal crypts of Morgagni: the cause of perianal abscess and fistula-in-ano. J Pediatr Surg 1987; 22 (03) 203-204
    CrossrefPubMedGoogle Scholar
  • 8 Serour F, Somekh E, Gorenstein A. Perianal abscess and fistula-in-ano in infants: a different entity?. Dis Colon Rectum 2005; 48 (02) 359-364
    CrossrefPubMedGoogle Scholar
  • 9 Fitzgerald RJ, Harding B, Ryan W. Fistula-in-ano in childhood: a congenital etiology. J Pediatr Surg 1985; 20 (01) 80-81
    CrossrefPubMedGoogle Scholar
  • 10 Afşarlar CE, Karaman A, Tanır G. , et al. Perianal abscess and fistula-in-ano in children: clinical characteristic, management and outcome. Pediatr Surg Int 2011; 27 (10) 1063-1068
    CrossrefPubMedGoogle Scholar
  • 11 Berger S, Eble F, Coerdt W, Kinderchir FLZ. 1998 . Perianale Fisteln im Kindesalter;7:196–204
  • 12 Al-Salem AH, Laing W, Talwalker V. Fistula-in-ano in infancy and childhood. J Pediatr Surg 1994; 29 (03) 436-438
    CrossrefPubMedGoogle Scholar
  • 13 Eisenhammer S. The internal anal sphincter and the anorectal abscess. Surg Gynecol Obstet 1956; 103 (04) 501-506
    PubMedGoogle Scholar
  • 14 Rosen NG, Gibbs DL, Soffer SZ, Hong A, Sher M, Peña A. The nonoperative management of fistula-in-ano. J Pediatr Surg 2000; 35 (06) 938-939
    CrossrefPubMedGoogle Scholar
  • 15 Watanabe Y, Todani T, Yamamoto S. Conservative management of fistula in ano in infants. Pediatr Surg Int 1998; 13 (04) 274-276
    CrossrefPubMedGoogle Scholar
  • 16 Kubota M, Hirayama Y, Okuyama N. Usefulness of bFGF spray in the treatment of perianal abscess and fistula-in-ano. Pediatr Surg Int 2010; 26 (10) 1037-1040
    CrossrefPubMedGoogle Scholar
  • 17 Ohya T, Usui Y, Okamoto K, Inoue Y, Arii S, Iwai T. Management for fistula-in-ano with Ginseng and Tang-kuei Ten Combination. Pediatr Int 2004; 46 (01) 72-76
    CrossrefPubMedGoogle Scholar
  • 18 Emile SH, Elfeki H, Abdelnaby M. A systematic review of the management of anal fistula in infants. Tech Coloproctol 2016; 20 (11) 735-744
    CrossrefPubMedGoogle Scholar
  • 19 Oh JT, Han A, Han SJ, Choi SH, Hwang EH. Fistula-in-ano in infants: is nonoperative management effective?. J Pediatr Surg 2001; 36 (09) 1367-1369
    CrossrefPubMedGoogle Scholar
  • 20 Ommer A, Herold A, Berg E. , et al. German S3 guidelines: anal abscess and fistula (second revised version). Langenbecks Arch Surg 2017; 402 (02) 191-201
    CrossrefPubMedGoogle Scholar