Perianal (around the anus) abscess is a common disease in childhood. In older children, underlying immunodeficiency, colonopathy, etc. is likely to be related to underlying factors. It should also be investigated especially if it is observed under 6 months of age, but the relationship with underlying factors is very rare in this age group. The vast majority of patients under the age of two are male.
The lesion first begins as an erythematous swelling around the anus, then redness, swelling, and a soft, white area in the center of the lesion. It has been reported that while perianal abscess often occurs following an acute infection in the glands in the anus in adult patients, congenital anomalies in the anal crypts (recesses) cause abscess and fistula formation in children, and anal crypt inflammation often triggers abscess formation, especially in infants younger than one year old. It has also been claimed that in the womb, androgen excess or imbalance in androgen-estrogen levels during pregnancy lead to abnormal and thick anal crypt formation, which triggers the formation of perianal abscess and fistula.
Approximately 50% of patients with perianal abscess have an underlying cause. In babies younger than one year old; Patients who underwent rectal dilatation or myotomy due to imperforate anus or Hirschsprung’s disease, cytotoxic chemotherapy, severe combined immunodeficiency, cyclic neutropenia, hyper Ig-M syndrome, Schwachman-Diamond syndrome, autoimmune neutropenia and glycogen storage disease, congenital and acquired neutropenic conditions such as Type Ib . The factors observed in children older than one year are; HIV infection, inflammatory bowel diseases such as Crohn’s and ulcerative colitis, diabetic ketoacidosis, septic granulomatosis and juvenile polyarthritis treated with high-dose corticosteroids, rarely enterobius vermicularis infection, sexual abuse or granulomatous infection are causes.
Clinically, most patients with perianal abscesses have local symptoms, rarely accompanied by restlessness and fever. On physical examination, no findings or accompanying pathology are detected except for local tenderness and redness. Blood values rarely vary.
The classical treatment method of perianal abscess is incision and drainage of the abscess, examination for possible accompanying fistula and, if necessary, fistulotomy or fistulectomy. However, some authors do not recommend detailed examination for the underlying fistula due to the risk of injury to the anal sphincter. However, as an opposing view, some authors claim that investigating the fistula with a careful and sensitive method and treating it by performing fistulotomy or fistulectomy when necessary, seriously reduces the risk of recurrence of the disease. It is stated that the risk of fistula formation is higher especially in cases under the age of two, and the use of antibiotics in the preoperative period does not significantly reduce this risk.
During the surgical drainage of the perianal abscess, microorganisms such as E. Coli, Staph Aureus, Klepsiella species and Bacteriodes Fragilis grow in the culture material taken.
