Purpose Evaluate outcomes of conservative management of selected cases of perianal abscesses in infants.
Methods Data were retrospectively collected during August 2014-January 2018
for selected patients < 24 months, treated conservatively for perianal abscess.
Results Nineteen male patients met conservative approach criteria: spontaneous drainage into the anal canal (8) or perianal skin(4) and phlegmonous infiltrate without evident fluctuation (7). Mean age of symptom onset was 8.4 months. Mean length of care in the community was 3 days. Twelve patients were managed for the first time. Four underwent 1-4 previous drainage procedures, one a previous spontaneous drainage and two were managed conservatively with antibiotics. Five patients received oral antibiotics prior to presentation. Upon diagnosis, intravenous antibiotics were initiated in 18 patients and orally in one. Average hospitalization was 39 hours. Three patients failed conservative management and underwent surgical drainage; two were lost to follow-up. During a mean follow-up of 22.4 months, a single recurrent episode of abscess was managed conservatively in two patients and surgically in one at another institution, while one patient developed fistula-in-ano that healed. Meaning that surgical intervention was prevented in 76%of the patients available for follow-up.
Conclusions Perianal abscesses are amenable for conservative management in selected cases. Avoiding surgical intervention is advantageous, especially in view of the high recurrence rate.
