Perianal Nursing is Important: Prevention and Treatment of Infants’ Perianal Abscess and Anal Fistula

Some diseases are so small in the eyes of doctors that not many doctors are willing to study them, but these diseases have brought a lot of pain to children and also added a lot of troubles to parents. Perianal abscess in children is such a disease.

Perianal abscess is not uncommon in pediatric surgery clinics. Many parents run to the hospital every day for this reason, queuing, registering and changing dressings. Very not easy for the wound to grow well, the abscess recurs after a while, and then incision and drainage, queuing, registering and changing dressings are repeated again and again, repeated several times and delayed for several months. After a while, the doctor also said that anal fistula was formed and surgery was needed, which was really maddening.

Peri-anal abscess that is not easy to find

As the name implies, Perianal abscess is an abscess that grows around the anus. After the bacterial infection, The lacuna formed after necrosis and liquefaction of perianal tissue. Like infection lesions in other parts, Perianal abscess is also mainly manifested as redness, swelling and heat pain, but the child cannot tell when he is young, and the abscess position is hidden. Most of the abscesses are relatively small and seldom cause systemic symptoms such as fever. Therefore, it is not easy for parents to find out, and it is often the child who cries when defecating or sitting that attracts attention.

The cause of perianal abscess is not so clear, Many sick children were found to have a deeper recess (see picture) than normal children, Therefore, it is speculated that this abnormal anal recess may be related. Children under 2 years old, Perianal abscess basically occurs in boys. Some people have found that the testosterone level of boys is relatively high in January-March, and January-February is just a peak period of perianal abscess onset, so there is also speculation that it may be related to the sex hormone level of children. The sex tendency of perianal abscess over 2 years old is not so obvious, and some are secondary to Crohn’s disease.

Drainage or no drainage?

Perianal abscesses vary in size, The smaller ones are only the size of rice grains, It is possible to break and heal before you know it. There are also large ones the size of walnuts. Even lead to redness and swelling of the whole buttocks, requiring hospitalization. 90% of perianal abscess is one or two. If the anus is regarded as a clock, abscess mainly occurs at 3 o’clock and 9 o’clock, accounting for about 70%. It is precisely because the disease is very small and the research at home and abroad is not deep enough. Like the unclear pathogenesis, its treatment methods are also controversial.

According to the principles of surgical treatment, As long as the surface of the abscess is white, You can see the pus, The pyogenic cavity softens and feels fluctuating. Should open drainage, the pus drainage is good quickly, the vast majority of abscesses are treated in this way, including perianal abscess. However, perianal abscess does have a high recurrence rate (about 1/3) after incision and drainage, and many will form anal fistula (about 1/5 ~ 1/3), that is, a chronic inflammatory fistula is formed between the pus cavity external mouth and anal canal.

But in 2007, In an article published in the American Journal of Pediatrics, It is believed that the nature of perianal abscess under 1 year old is different from that of perianal abscess of other age groups. According to the case summaries from the two medical centers, It was found that only perianal nursing and anti-infection treatment were carried out for perianal abscess within 1 year old. The rate of anal fistula in the later period is much lower than that of children undergoing incision and drainage. Children who took antibiotics had a lower incidence of anal fistula. This conclusion broke the common sense of everyone. Therefore, some people soon raised objections, saying that this was a retrospective study, not a random grouping, and the size of the abscess was not recorded. Perhaps doctors took incision and drainage for large abscesses and conservative treatment for small abscesses. Naturally, the probability of anal fistula was different for different abscesses.

The truth is, The conclusions of most studies are different from those of that one. For example, in another article in the 2011 International Journal of Pediatric Surgery, There was no statistical difference in recurrence rate and anal fistula rate between incision and drainage and conservative treatment. And the incidence of the former is lower. As to whether antibiotics are needed, Many studies have different conclusions. Some say antibiotics can reduce the probability of recurrence and anal fistula formation, but others believe that the use of antibiotics cannot reduce the occurrence of anal fistula. Generally speaking, the effect of antibiotics on the treatment of perianal abscess is controversial.

In clinical practice, For smaller ones, Incomplete liquefied abscess, Most doctors also take conservative treatment, Including perianal cleaning care, You can also take a sit bath with potassium permanganate solution after defecation. Some doctors also recommend taking antibiotics orally, Some of them healed slowly. But for those who grew slowly, The liquefaction is obvious, Like seeing pus, An abscess that feels fluctuating, Most doctors will also suggest incision drainage, put aside recurrence, anal fistula and other problems, incision although some pain to children, but after incision the pus clean, can also relieve local inflammatory stimulation, relieve the pain of children. For patients with relatively young age and systemic symptoms such as fever, many will be hospitalized.

Both prevention and treatment require careful perianal care

Clinically, it is found that many children suffer from diarrhea, Therefore, it is not excluded that stool pollution stimulates anus to induce, As for whether anal fissure can be induced is not clear at present, but it is not wrong to keep a good diet and defecation habits, avoid diarrhea and constipation, and do a good job in cleaning the anal perianal area. The baby’s skin is very delicate. In order to avoid infection caused by friction injury, wipe the anus with soft and non-irritating wet wipes as much as possible.

Because it’s close to the anus, Wounds can easily be contaminated with excrement, Therefore, after incision, the wound care should also be strengthened. Clean in time, It is important to keep dry, For patients with recurrent abscess, The treatment principle is similar to that of the first onset. For those who form anal fistula, It is not that there is no chance of self-healing, Some articles say that the self-healing rate is about 1/6, But it takes an average of more than five months, If it doesn’t heal for a long time, Fistulotomy (including thread hanging) or fistulectomy is performed. The good news is that most anal fistulas in children are simple. It is not as complicated as that of adults, the prognosis is better, and basically does not affect anal function. For children over 2 years old, the treatment method is similar to that of adults’ perianal abscess, mainly incision and drainage, but it is necessary to guard against whether it is secondary to other immune diseases.

Author: Pei Honggang

The article was reprinted by Clove Garden authorized by the author.