Nonoperative management of perianal abscess in infants is associated with decreased risk for fistula formation.
OBJECTIVE
We sought to determine the frequency of progression in infants of perianal abscess with and without surgical drainage to fistula in ano to optimize a treatment plan for these children.


METHODS
A retrospective cohort study was conducted of all patients who were < or = 1 year of age and presented with perianal abscess to 2 pediatric tertiary care institutions during a 10-year period (January 1995 to February 2005, inclusive). Patients were divided into those who underwent surgical drainage and those who did not, and the rate of subsequent fistula formation was determined.


RESULTS
Of 165 children initially identified, follow-up was available for 140. Ninety-four percent of children were male. Mean age was 4.2 +/- 3.1 months. Of the 140 patients, 83 abscesses were drained and 57 were not drained. Of patients who underwent surgical drainage, 50 developed a fistula, whereas of those who did not undergo drainage only 9 developed a fistula. Synchronous administration of antibiotics (intravenous or oral) used in 57 of 58 patients from 1 institution was associated with an even greater decrease in fistula formation (12.5%) in the undrained population.


CONCLUSIONS
Perianal abscess formation in infants who are younger than 12 months is a separate entity from abscess formation in older age groups. In this largest study to date, a combined center series of patients who presented to 2 academic pediatric hospitals with infantile perianal abscess, local hygiene and systemic antibiotics without surgical drainage minimized formation of fistula in ano.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Emily R
ER
Christison-Lagay
Jason F
JF
Hall
Paul W
PW
Wales
Karen
K
Bailey
Andrew
A
Terluk
Allan M
AM
Goldstein
Sigmund H
SH
Ein
Peter T
PT
Masiakos
D000038:Abscess / Q000150:complications / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001004:Anus Diseases / Q000150:complications / Q000628:therapy*; D015331:Cohort Studies; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D012003:Rectal Fistula / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012306:Risk
D000900:Anti-Bacterial Agents