Perianal and Perirectal Abscesses Workup

  • Author: Nelson G Rosen, MD, FACS, FAAP; Chief Editor: Marleta Reynolds, MD   more...
 
Updated: Jan 14, 2010
 

Laboratory Studies

Otherwise healthy babies with perianal abscess or fistula require no laboratory studies. Some clinical scenarios may justify obtaining a complete blood cell (CBC) count and/or culture of perianal abscess drainage; however, these studies are not of great utility in focusing therapy and can usually be omitted without risk or detriment to the patient.

Blood counts and cultures should be obtained in all patents who are immunocompromised by any cause, such as inflammatory bowel disease (IBD), an immune disorder, or malignancy.

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Imaging Studies

No imaging studies are necessary for the evaluation of otherwise healthy infants with perianal abscess or fistula-in-ano.

In older children with a greater likelihood of Crohn disease or any older child who appears systemically ill, CT scanning of the pelvis may be required to rule out a deep-space infection.

Referral to a gastroenterologist is recommended in all children with suspected Crohn disease once the abscess has been treated. Studies to evaluate for other Crohn disease manifestations include a contrast enema and a small-bowel contrast study.

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Diagnostic Procedures

Colonoscopy with biopsy may be needed to confirm Crohn disease. Endoscopy is not required in otherwise routine cases.

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Histologic Findings

No histology is obtained in the routine treatment of perianal abscess and fistula.

Biopsy may be performed in older children with a chronic fistula to evaluate for granulomas as a sign of Crohn disease.

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Contributor Information and Disclosures
Author

Nelson G Rosen, MD, FACS, FAAP  Assistant Professor of Surgery and Pediatrics, Albert Einstein College of Medicine; Attending Pediatric Surgeon and Director, Pediatric Trauma Center, Department of Pediatric General Surgery, Schneider Children's Hospital

Nelson G Rosen, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, American Trauma Society, Association of Military Surgeons of the US, Canadian Association of Pediatric Surgeons, and Eastern Association for the Surgery of Trauma

Disclosure: Nothing to disclose.

Specialty Editor Board

Kurt D Newman, MD  Vice Chairman, Department of Pediatric Surgery, Children's National Medical Center; Professor, Departments of Surgery and Pediatrics, George Washington University School of Medicine

Kurt D Newman, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Andre Hebra, MD  Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Children's Oncology Group, Florida Medical Association, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

H Biemann Othersen Jr, MD  Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina

H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD  Professor of Surgery, Northwestern University, The Feinberg School of Medicine; Head, Department of Surgery and Surgeon in Chief, Head, Division of Pediatric Surgery, Children's Memorial Hospital of Chicago

Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association

Disclosure: Nothing to disclose.

Acknowledgments

The author wishes to acknowledge Dr. Alberto Pena and the late Dr. James Warden. Dr. Warden was an eminent pediatric surgeon, and, on a visit to his friend and fellow eminent pediatric surgeon (and the author's mentor) Dr. Pena, Dr. Warden communicated his technique of nonoperative management of fistula-in-ano. This radical concept led to a study in this regard in which the author extensively participated and thereby inherited Dr. Pena's passion for this subject and for the optimal care of children with this condition.

The author would also like to thank Dr. Peter Masiakos and his colleagues for their further efforts to advance the nonoperative treatment of children with perianal abscess with the thought that avoiding fistula-in-ano is better than treating it.

The authors and editors of eMedicine also gratefully acknowledge the contributions of prior authors Asma Al Mannaie, MBBS, and Pramod S Puligandla, MD, MSc, FRCSC, FACS, to the development and writing of this article.

References

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  2. Fitzgerald RJ, Harding B, Ryan W. Fistula-in-ano in childhood: a congenital etiology. J Pediatr Surg. February/1985;20(1):80-81. [Medline].

  3. [Guideline] Christison-Lagay ER, Hall JF, Wales PW, et al. Nonoperative management of perianal abscess in infants is associated with decreased risk for fistula formation. Pediatrics. September 2007;120(3):e548-52. [Medline]. [Full Text].

  4. [Guideline] Rosen NG, Gibbs DL, Soffer SZ, Hong AR, Sher M, Pena A. The Nonoperative Management of Fistula-in-Ano. J Pediatr Surg. June 2000;35(6):938-939. [Medline].

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  7. Ho YH, Tan M, Chui CH, et al. Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses. Dis Colon Rectum. Dec 1997;40(12):1435-8. [Medline].

  8. Laberge JM. Perianal abscess and fistula-in-ano in infants. J Pediatr Surg. Dec 1998;33(12):1848. [Medline].

  9. Macdonald A, Wilson-Storey D, Munro F. Treatment of perianal abscess and fistula-in-ano in children. Br J Surg. Feb 2003;90(2):220-1. [Medline].

  10. Murthi GV, Okoye BO, Spicer RD, et al. Perianal abscess in childhood. Pediatr Surg Int. Dec 2002;18(8):689-91. [Medline].

  11. Nix P, Stringer MD. Perianal sepsis in children. Br J Surg. Jun 1997;84(6):819-21. [Medline].

  12. Serour F, Gorenstein A. Characteristics of perianal abscess and fistula-in-ano in healthy children. World J Surg. March 2006;30(3):467-472. [Medline].

  13. Serour F, Somekh E, Gorenstein A. Perianal abscess and fistula-in-ano in infants: a different entity?. Dis Colon Rectum. February 2005;48(2):359-64. [Medline].

  14. Tang CL, Chew SP, Seow-Choen F. Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscesses with proven internal opening. Dis Colon Rectum. Dec 1996;39(12):1415-7. [Medline].

  15. [Guideline] Watanabe Y, Todani T, Yamamoto S. Conservative management of fistula in ano in infants. Pediatr Surg Int. Apr 1998;13(4):274-6. [Medline].

 
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