Fistula in ano in infants and children : implications and management

A fistula is an abnormal tube-like passage that extends from a normal cavity or tube to a free surface or to another cavity. A fistula in ano is a fistula that develops near the anus. Fistula in ano in infants and children mostly affects males; symptoms develop at less than 12 months of age; multiple, separate passages develop in less than 20 percent of patients; and the problem does not usually recur. These characteristics differ from those of fistula in ano in adults. Forty cases of fistula in ano of unknown origin in infants and children were reviewed. The patients, which included 33 boys and 7 girls, ranged in age from four weeks to six years, with an average age of diagnosis of 13.1 months. All patients had a draining, hardened pus-filled lesion; 13 patients had an abscess in the rectal area; five patients had constipation problems; and four children had an anal fissure, a linear ulcer near the anus. The number and location of the fistula in these patients are described. The fistula were initially treated by meticulous perianal hygiene, sitz baths, oral antibiotics, stool softeners, and mineral oil. This approach completely resolved the fistulae in three cases, but the remaining 37 required surgery. Most children with this disorder underwent fistulotomy, the removal of the fistula, and partial sphincterotomy, the cutting of the sphincter muscle that closes the anus. These patients should be followed for signs of any associated anorectal disease. (Consumer Summary produced by Reliance Medical Information, Inc.)