Anorectal Abscess in Children Clinical Presentation

Updated: Jul 05, 2018
  • Author: Nelson G Rosen, MD, FACS, FAAP; Chief Editor: Robert K Minkes, MD, PhD  more...
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Presentation

History and Physical Examination

Anorectal abscesses often present within the first few months of life. A perianal abscess, which in many ways is the same as a small pimple, appears as a red swollen area located just outside the anus; this is usually first noticed during a diaper change and may be tender to the touch. Affected children may appear to be irritable but are commonly asymptomatic. Differentiating simple irritability from true tenderness due to perianal abscess can pose a challenge to the clinician but is important for reassuring parents. [6, 7]

Infants with perianal abscesses generally do not have underlying medical conditions that predispose them to abscesses. Perianal abscess and fistula-in-ano are unrelated to diaper rash.

Older children with anorectal abscesses fall into two roughly equally sized categories. The first category consists of otherwise completely healthy children who have no significant risk factors or history of symptoms suggestive of inflammatory bowel disease (IBD). Many children are constipated; constipation is a risk factor for anal fissure but not for anorectal abscess.

The second category consists of older children with IBD. Some children with a known history of Crohn disease present with a new abscess or fistula. In many cases, the first manifestation of IBD or Crohn disease in a child is perianal abscess or fistula. Elements in the history that suggest IBD include weight loss, failure to thrive, diarrhea, and chronic abdominal pain.

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Complications

Because the likelihood of recurrent abscess and fistula formation is high even after adequate surgical drainage, surveillance is necessary. Complex or nonhealing perianal abscesses and fistulas may be signs of Crohn disease. Chronic drainage or recurrent abscess may indicate a fistula.

In otherwise healthy patients, complications of anorectal abscess are extremely rare and are most commonly associated with Crohn disease, neutropenia, or an immunocompromised state.

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