Clinical characteristics and treatment of perianal abscess in neonates

Objective To evaluate the clinical characteristics and the clinical outcomes of perianal abscess(PA) in neonates. Methods A retrospective review was performed on the collected data of 185 patients of PA in neonates prospectively admitted to Binzhou Medical University Hospital from January 2008 to December 2015.Patients were divided into 2 groups on the parents′ intention: nonsurgical treatment and surgical treatment, the standard surgical treatment for PA was incision and drainage with the use of packing.The standard surgical treatment for PA was surgical incision drainage of lower abscess under local anesthesia by the use of filling tamponade iodoform gauze, while the patients receiving conservative treatment took hip bath perianally with topical 1︰5 000 potassium permanganate, besmearing erythromycin eye ointment outside locally.Incision-thread-drawing procedure was recommended in fistula-in-ano(FIA)after 6 months.Antibiotics were administered in all patients in the early days.The clinical data of age, gender, accompanying diseases, abscess amount and location, treatment approach, healing time and recurrence rates were analyzed with statistical method. Results All patients were boys, time of visiting hospital was 1-25 day, the average time 7.5 days; 60 cases (32.4%)had neonatal diarrhea, 45 cases (24.3%)had neonatal jaundice, but no patients had severe fever.A single skin lesion was present in 145 patients(78.4%), 2 lesions in 30 patients(16.2%), and 10 patients had 3 lesions(5.4%). The most commonly affected sites were at 9 o′ clock clockwise direction with 115 (62.2%)lesions on lithotomy position, followed by 3 o′clock clockwise direction with 65(35.1%) lesions by 1 o′clock clockwise direction with 3 (1.6%) lesions and 6 o′ clock clockwise direction with 2 (1.1%) lesions.Bacteria cultures were obtained from 123 patients (90.4%, 123/136 cases) of surgical treatment and 35 patients (71.4%, 35/49 cases) of nonsurgical treatment obtained the results of bacteria culture.The average healing time was (21±2) days (10-60 days) in the surgical treatment group, and (36±3) days (9-90 days) in the nonsurgical treatment group, 7 out of 136(5.1%)patients had a recurrence with surgical treatment, incision drainage was performed again with the use of packing, and FIA was not found, 10 out of 49 (20.4%) patients had a recurrence with nonsurgical treatment group, and 6 out of 49 (12.2%) were spontaneously resolves within the first year of life, 4 out of 49(8.1%)developed into FIA, incision-thread-drawing procedure was performed after 6 months.The significant difference was observed between and nonsurgical treatment and surgical treatment in healing time (t=-6.707, P=0.000), recurrence (χ2=11.347, P=0.001) and FIA formation rate (χ2=10.054, P=0.002). Conclusions PA is an entity in neonates.Incision and drainage of PA is an effective and safe therapy in the early days.Surgery for PA may result in low recurrence rates, a low rate of evolution toward FIA, and a short healing time, which should be considered as the primary treatment.The key procedure is to keep the drainage unobstructed by the use of filling gauze drainage to prevent crissum abscess recurrence.Postoperative care with antibiotics is effective to shorten hospital stays. Key words: Perianal abscess; Infant, newborn; Surgical treatment; Incision and drainage