Causes of perianal abscess formation in babies

Written by Li Jiao Yan
Neonatology
Updated on September 06, 2024
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In pediatric outpatient surgery, perianal abscesses are not uncommon, and many parents visit the hospital daily for this issue. They wait, register, and change dressings. Once the wound heals, it often recurs after a while, leading to repeated incisions and drainage, persisting for several months. Eventually, the doctors say a fistula has formed and surgery is required. What exactly causes such troublesome perianal abscesses? The cause of perianal abscesses is not completely clear, but many affected children have been found to have deeper anal crypts than normal, so it's speculated that it may be related to this abnormality. In children under two years old, perianal abscesses mostly occur in boys. Some studies suggest that testosterone levels are higher in boys aged 1-3 months, coinciding with a peak period for perianal abscess incidences, leading to speculation that it may be related to the child’s hormone levels. In children over two years old, there is less gender bias in the incidence of perianal abscesses, and some cases are secondary to Crohn’s disease.

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Written by Yu Xu Chao
Colorectal Surgery
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Differences between minimally invasive surgery and traditional surgery for perianal abscess

In clinical practice, perianal abscesses are primarily due to infection and inflammation of the anal glands, which then leads to the formation of red and swollen masses around the anus, causing pain and swelling near the anus. If not treated surgically in a timely manner, it can lead to necrotizing fasciitis or anal fistulas. Minimally invasive surgery for perianal abscesses mainly aims to minimize damage to the anal sphincter during the procedure. Techniques such as loop drainage can be employed to preserve it, whereas traditional surgery generally involves larger incisions, but provides better drainage and has a lower recurrence rate post-operatively. However, leakage or moisture in the anal area can occur after traditional surgery. For minimally invasive surgery for perianal abscesses, there is a relatively higher recurrence rate since the drainage may not be as effective. However, the integrity of the anus post-surgery is better preserved and incidents of leakage are less frequent. The choice of surgical method should still be based on the severity of the perianal abscess.

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Can I eat eggs with a perianal abscess?

Patients with perianal abscess can eat eggs, but during the acute onset period of a perianal abscess, besides sticking to a light diet, it is more important to seek surgical treatment as soon as possible. A perianal abscess is an acute infectious disease near the anal sinuses. Typically, it presents with severe local pain in the anus. Once pus forms, it is encapsulated in the abscess cavity and needs to be surgically drained as soon as possible to remove the infection thoroughly. This helps to prevent further enlargement of the abscess cavity and worsening of the condition. Furthermore, in the early postoperative period, patients can consume liquid foods and eat eggs in moderation or other easily digestible foods. However, they should avoid spicy and irritating foods such as chili peppers and seafood.

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Colorectal Surgery
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Symptoms of perianal abscess

Perianal abscess is a common acute infectious disease in proctology. When a perianal abscess occurs, the patient generally experiences severe pain in the anal area accompanied by local skin redness, increased skin temperature, and even systemic fever and fatigue symptoms due to the local abscess. During an outbreak of a perianal abscess, the abscess cavity or pus encapsulation can generally be clearly seen under perianal color ultrasound, and it is necessary to promptly carry out perianal abscess incision and drainage surgery, as well as further one-time radical surgery for the perianal abscess. If not treated actively, a perianal abscess might rupture and likely form an anal fistula, the treatment of which is also primarily surgical.

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Colorectal Surgery
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How many days does the skin around an anal abscess fall off?

During the acute phase of a perianal abscess, if rubber band ligation surgery is performed, the duration of the rubber band falling off generally depends on the location of the lesion. For superficial local perianal abscesses, the rubber band typically falls off within one to ten days. For high-position complex perianal abscesses or those accompanied by anal fistulas, the falling off of the rubber band might take about ten days. In some cases where the rubber band falls off slowly, it may require a doctor's dressing change and assistance to weaken or detach the local rubber band. Do not pull off the rubber band yourself to avoid injuring the local sphincter, which could lead to decreased or abnormal tightness around the anus.

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Does a second surgery for a perianal abscess hurt?

When it comes to a second surgery for a perianal abscess, it is generally recommended to proceed directly with spinal anesthesia. Simple local anesthesia might be more painful for the patient, as spinal anesthesia does not cause pain sensations. If there is pain after the surgery, one can opt for oral painkillers or a combination of pain relief pump treatments. Alternatively, pain relief gel can be applied to the wound to alleviate pain before each dressing change. Therefore, after the onset of a perianal abscess, whether it is the first or second surgery, it is essential to operate as soon as possible, and to disinfect and change dressings postoperatively to prevent pseudo-healing or secondary recurrent infections. To relieve pain, painkillers can be chosen. Before or after each bowel movement, one may use clean water for local cleansing to soothe the sphincter and prevent fecal residue.