= Abstract =
Anal Fistula and Perianal Abscess in Pediatric and Adolescent Patients
Seong Chul Kim, M.D., Jin Cheon Kim, M.D. and In Koo Kim, M.D.
Department of Surgery, University of Ulsan, College of Medicine and Asan Medical Center Seoul, Korea
Anal fistula and perianal abscess in pediatric patients have been reported to have several characteristics, e.g. prevalent in less than 2 years of age, male preponderence, straight course of tract, and low type of fistula. We performed a retrospective study of twenty nine pediatric patients to see these characteristics comparing with the transitional age group of adolescents.
Between June 1989 and December 1993, twenty-nine pediatric « 15year-old) and sixteen adolescent patients(;;::; 15,
<
25 year-old) with anal fistula and peri- anal abscess were treated by surgical intervention.Perianal abscess and anal fistula in the pediatric group had the predilection for male(lOO%), age less than two years(72.4%), low type(100%), and lateral 10- calization(87.5%). But the features of the adolescent group were similar to those of adult.
Twenty-one(87.5%) and 10(66.7%) enteric bacterial colonies were isolated from 16 pediatric and 11 adolescent patients, respectively.
Considering the predominance of low type and the organisms cultured in the pediatric group, crypt-glandular infection seems to be a major preceding event.
Incision and drainage were sufficient for cure in 15 among 16 perianal abscesses, and fistulas were cured by either fistulotomy or fistulectomy in all the 14 pa- tients. The importance of effective drainage of perianal abscess and fistulotomy including internal opening cannot be overemphasized.
Index Words: Anal fistula, Perianal abscess, Childhood
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~ i5}9tct (li 1).Table 1. Presenting Symptoms in 19 Perianal Abscess of Pediatric Patients
Symptoms Number( %)
Irritability 10(43.5)
Pain 4(17.4)
Fever 4(17.4 )
Swelling 3(13.0)
Mass 2(8.7)
Table 2. Location of Perianal Abscess and Inernal Opeing of Anal Fistula
Age Anterior Posterior Right Left
<
15years4(10.3%) 4(10.3%) 13(33.3%) 18(46.1 %) (n=39)
lS-25years
4(23.5%) 9(52.9%) 1( 5.9%) 3(17.7%) (n=17)
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Table 3. Isolated Causative Organisms in Anal Fistula and Perianal Abscess Pediatric patients
(16/29)
Adolescent patients (11/16) Enteric bacteria
E. coli Klebsiella Enterobacter Proteus Citrobacter Bacteroides
21(87.5% ) 10(66.7% )
14 8 2 2 1 1 1
1
o
1
o o
Non-enteric bacteria Peptpstreptococcus S. aureus
3(12.5%) 1
5(33.3%)
o o
S. viridans 1 2
Coag.( -) staphylococcus 0 2
S. pneumoniae 0
* :
Mixed infection is noted in 8 patients of the pediatric patients and 4 of the adolescent patients.20r----~---
15
~
'" 10
m "
5
o 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 age(year)
Fig 1. Age distribution of anal fistula and peri- anal abscess in pediatric patients.
right 33.3%
posterior 10.3%
anterior 10.3%
younger than 15 years
anterior 23.5%
posterior 52.9%
from 15 to 25 years
Fig 2. Location of perianal abscess and external opening of anal fistula.
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