Perianal abscess and anal fistula in infancy and childhood.: A congenital etiology?

Background. Perianal abscess and anal fistula in childhood are commonly treated in the same way as abscess and fistula in adults. We questioned whether they represent a crypto-glandular infection, as in adults, or two different diseases with the same symptoms. Materials and Methods. We retrospectively analyzed all medical records of 80 children (seven male, 73 female) who underwent surgical treatment for primary perianal abscess or primary anal fistula during a 10-year period. The records were analyzed concerning age at appearance of lesion, sex, diagnosis (fistula and/or abscess), and anatomic localization of the lesion. Results. Of all the children, 67.5% were treated during their 1st year of life and another 10% during their 2nd year (group 1: 77.5%, n=62). Only 22.5% were 3 or older (group 2, n=18). Group 1 contained significantly more male infants (m:f 30:1). However, much more balanced sex distribution was detected in group 2 (m:f 2.6:1), similarly to adults. Analyzing anatomic localization, a second important difference could be found: in contrast to group 2, almost two thirds of all anal fistulas/ abscesses in group 1 were localized horizontally between 3:00 and 9:00 o'clock in crown-rump position. Conclusions. Divergences in preference of age, sex, and localization suggest a congenital etiology for anal fistulas and perianal abscesses in children.