Treatment of perianal abscess in children: spontaneous drainage or incision-drainage?

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Erten E. E., ÖZTORUN C. İ., Ertürk A., GÜNEY D., Bostancı S. A., Öcal M. E., ...More

Annals of Pediatric Surgery, vol.18, no.1, 2022 (ESCI) identifier

  • Publication Type: Article / Article
  • Volume: 18 Issue: 1
  • Publication Date: 2022
  • Doi Number: 10.1186/s43159-022-00201-3
  • Journal Name: Annals of Pediatric Surgery
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, Directory of Open Access Journals
  • Keywords: Child, Fistula-in-ano, Incision-drainage, Perianal abscess, Recurrence, Spontaneous drainage
  • Ankara Yıldırım Beyazıt University Affiliated: Yes


© 2022, The Author(s).Background: The aim of the study is to evaluate the clinical characteristics and compare the treatment methods for perianal abscesses by assessing our treatment experiences. Methods: We have retrospectively analyzed the records of the children who received perianal abscess and fistula-in-ano treatment between January 2014 and January 2022. Demographic information of the patients, complaints, treatment procedures, abscess recurrence, and development of fistula-in-ano was evaluated. Patients with systemic diseases and inflammatory bowel diseases were excluded from the study. Results: A total of 312 children (230 boys, 82 girls) were included in the study. The median age was 24.3 ± 18.1 months (1–216). In the first examination, 61 (19.5%) patients had fistula-in-ano and 25 1(80.5%) patients had a perianal abscess. The most common symptoms were erythema in the perianal region, mass, constipation, rectal bleeding, and inability to defecate. Spontaneous drainage was determined in 34.3% (n = 86) of the perianal abscess, and 65.7% (n = 165) of perianal abscesses were treated with incision-drainage without general anesthesia and systemic antibiotherapy. In the follow-up, fistula-in-ano formed in 27 patients who had a perianal abscess. Twenty-four of the patients who developed fistula-in-ano, were seen after spontaneous drainage, and 3 of them were seen after incision drainage. Perianal abscess recurred in 64 patients. Spontaneously drained abscess significantly increased the development of fistula-in-ano (p = 0.001). However, recurrences in a perianal abscess (25.4%) do not increase the fistula-in-ano formation (p > 0.05). In fistula-in-ano treatment, 10 (11.5%) patients were resolved spontaneously, 70 (79.5%) patients were treated with fistulotomy and 8 (9%) patients were treated with fistulectomy. Conclusion: Treatment of perianal abscess and fistula-in-ano in children is still controversial. According to our results, incision-drainage and antibiotic usage in the treatment of the perianal abscess are the most appropriate treatment to decrease the rate of fistula-in-ano.