1. Françoise Smets Gastroentérologie et Hépatologie Pédiatrique
Perianal abscesses in children: Pitfalls in diagnosis and treatment BeSPGHAN-BELAPS October 2016
Françoise Smets
Gastroentérologie et Hépatologie Pédiatrique

2. Infection of an anal gland Young children (50% before 1 year old)
“Classic abscess”
Infection of an anal gland
Young children (50% before 1 year old)
Mostly boys
Red, painful, close to anal margin
Frequent underlying fistula
>70%
spontaneous healing?, minimum 10% recurrence
no recurrence if fistula is surgically treated ? (! sphincters)

3. Spontaneous healing ? 18 boys with abscess Age : 0.3-9.7 months
4 incision and drainage under local anaesthesia
3 for discomfort
1 for fever
3 fistulae with spontaneous healing
14 conservative follow-up
11 fistulae
All spontaneous recovery after a mean of 6 +/- 4 months
No antibiotics, no surgery
Rosen NG, Gibbs DL, Soffer SZ, Sher M, Pena A. J Pediatr Surg 2000:35;938-9

4. Spontaneous healing ? Christison-Lagay et al 2007 :
If incision-drainage : 50/83 fistulae (60%), lower if antibiotics
If no drainage : 9/57 fistulae (16%)
Ezer et al 2010 :
Incision-drainage : 85% recurrence
King et al 2010 :
Incision-drainage + fistula laid open : 12% recurrence
Malik et al 2010 (Cochrane – adults) :
Recurrence lower if fistula laid open
RR recurrence 0.13 ( )
King SK et al. J Paediatr Child Health 2010:46;273-4

5. Anal abscess with underlying disease
Crohn disease :
Older children, exceptional before 8-10 years old
Could be multiple abscesses or fistulae
Could be the only symptom!
Infectious disease :
Streptococcus (+ anitis)
Pseudomonas aeruginosa = echtyma gangrenosum (in case of immune-deficiency and/or leukemia)

6. Perianal disease at diagnosis in IBD patients
IBD patients < 20 years
511 (4.1%) with perianal disease
480 with Crohn disease (94%)
OR to be a girl = 0.63 ( , p<0.001)
No increased growth failure
Showed
Higher risk of surgery
Longer hospital stay
Higher hospital charges
Zwintscher NP et al. Int J Colorectal Dis 2015:30;1275-9

7. Perianal disease in Crohn patients and surgery
57 pediatric patients with at least 1 surgery
Median age 13 years (0.5-17)
63% boys
Skin tags 49%
Superficial fistulae 49%
Deep fistulae 37%
Superficial abscesses 68%
Deep abscesses 9%
Anal strictures 7%
Skin breakdown (19%)
Seeman NM et al. J Pediatr Surg 2015:50;140-3

8. Perianal disease in Crohn patients and infliximab
380 patients, 40 < 18 years
Lindsay JO et al. Aliment Pharmacol Ther 2013:38;52-61

9. What do surgeon think?