abscess, perianal

Perianal abscess means a boil-like infection in the area around the anus. It is not that uncommon a problem in children. There are basically two groups of children that are affected:

  • young children, usually boys under two years old with no predisposing conditions
  • older children with predisposing conditions

As stated, in younger children, there is usually no underlying illness or condition to explain the abscess formation. These abscesses will usually not require surgical drainage because this condition is self-limited. They will result in formation of a fistula between the interior of the anal canal and the outside skin around the anus that intermittently drains pus, but this usually disappears without further treatment by two years of age. If it doesn't, it might need to be surgically removed. There is no evidence that antibiotics really help the abscess condition. Local incision and drainage of the abscess is usually only done if the child is suffering a lot of discomfort from the abscess.

Older children with perianal abscess often have one of a long list of other medical problems, including drug-induced or autoimmune neutropenia, leukemia, acquired immunodeficiency syndrome, diabetes, Crohn's disease, prior rectal surgery for Hirschsprung disease or imperforate anus, or side effects from the use of immunosuppressant drugs. A perianal abscess in an older child to my mind would immediately suggest Crohn's disease as a top prospect. These kids can get pretty sick with this type of infection. In these cases, the outlook depends on the outlook for the underlying condition, so it can't be easily generalized.

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