Sir.—I have just seen the article entitled "Perirectal Abscess in Childhood" that appeared recently in the Journal (133:411-412, 1979). Although I would agree with the interpretation and findings given for infants, our experience with perianal abscess in the older child is somewhat different.
When perianal abscess occurs in patients older than 5 years of age, a thorough search should be made for the presence of chronic idiopathic inflammatory bowel disease. Perianal disease is much more likely to be a sign of Crohn's disease than of ulcerative colitis1 and may precede the onset of other gastrointestinal (GI) symptoms or occur independently when GI symptoms have subsided. Unlike perianal abscess at another age, these tend to be indolent, to heal poorly after surgical drainage, and often to be associated with enterocutaneous fistulas particularly from the rectum to the skin surrounding the anus. Young children have a lower incidence of this complication
GRAND RJ. Perirectal Abscess. Am J Dis Child. 1979;133(11):1203. doi:10.1001/archpedi.1979.02130110111029
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