Risk factors for therapy failure after surgery for perianal abscess in children

Purpose

The role of surgery in managing perianal abscesses in the pediatric population is debatable, and data on recurrence risk is rare. This study aimed to evaluate the efficiency of surgery for a perianal abscess in children and identify parameters that predict recurrence.

Methods

We performed a retrospective review of all children younger than age 14 requiring surgery for a perianal abscess from 2000 to 2018.

Results

Out of 103 enrolled patients, 27 (26%) had recurrent perianal disease. Recurrences appeared after a median of 5 months (range: 1-18 months), in 12 cases as perianal abscess and 15 cases as fistula in ano. Anal fistula probing was performed in 33% of all patients, of which 16 (15%) underwent fistulotomy. In univariate analysis, older age (p = 0.034), fistula probing (p = 0.006) and fistulotomy (p = 0.009) was associated with treatment success. History of perianal abscess, multilocal occurrence, and the presence of enteric flora in wound swabs was associated with treatment failure (p = 0.002, OR = 0.032). In multivariate analysis, anal fistula probing was independently associated with treatment success (p = 0.019, OR = 22.08), while the history of perianal abscess was associated with treatment failure (p = 0.002, OR = 0.032).

Conclusion

Our study identified probing for fistula as a predictor of therapy success, while the history of perianal abscess was identified as a predictor of treatment failure. Therefore, in all children with perianal abscess, fistula probing and if present, fistulotomy should be performed.

[Innervation anomalies of the thenar muscles (author's transl)]

In 337 patients various reasons led to an electromyographic investigation of the thenar muscles and frequently of the hypothenar muscles as well. Conduction velocity studies of the median and ulnar nerves were also performed. Five cases were found with concomitant innervation and two cases with exclusive innervation of the opponens pollicis muscle by the ulnar nerve. Two clinical cases in whom a severe median nerve injury has been overlooked due to this anomalous innervation demonstrate the importance of the awareness of this innervation variation.

The accessory deep peroneal nerve

The innervation of the right M. extensor digitorum brevis was investigated in 52 subjects with the aid of stimulation electromyography. In 13 cases (25%) a particular branch of the superficial branch of the peroneal nerve, the accessory deep peroneal nerve, could be identified. In 1 case it alone, and in 12 cases, together with the deep peroneal nerve, innervated the M. ext. dig. brevis. The significance of the awareness of this anomalous innervation is pointed out.