Background: Anal sepsis in children ranges from perianal abscess to
fistula-in-ano. It is mostly observed in boys younger than 2 years. Most
are treated conservatively. In contrast, anal sepsis in older children
presents significant similarities to that of adults and is predominantly
treated surgically. We report our outcomes after surgical treatment of
anal abscess and fistula-in-ano in children older than 2 years.
Patients and Methods: Ninety-eight (98) children were operated on for
anal abscess (46 patients; 47%) and/or fistula-in-ano (52 patients;
53%). Incision and drainage of the abscess was performed as
outpatients. In patients with fistulas, fistulotomy was the main
treatment approach. All patients were healthy without risk factors for
anal sepsis.
Results: In patients with anal abscess treated with incision and
drainage, low recurrence (13%) or fistula formation rates were
observed. Most anal fistulas were simple entities. Significant
involvement of the anal sphincter was found in 3 (6%) of 52 patients.
An abscess cavity between the anal canal and the perianal skin was found
in 4 (8%) of 52 patients, and an enlarged cryptic gland was found in 5
(10%) of 52 cases. Fistulotomy was performed in all patients with
additional seton placement in 3 (6%) of 52 and a cryptotomy in 5 (10%)
of 52 patients.
Conclusions: Anal abscesses in children are easily treated by incision
and drainage with low recurrence of perianal sepsis. Fistulas can be
treated successfully in most patients with a fistulotomy, whereas
complex fistulas are uncommon. (c) 2012 Elsevier Inc. All rights
reserved
