Post-Surgery Care for Pediatric Anal Fistula: When to Seek Further Treatment?

Post-fistula surgery

Hello, Dr.
Ke.
My child, who is currently one year and six months old, was suspected to have an anal abscess and fistula when he was six to seven months old.
Initially, there was just a lump near the anus without any pus formation.
Due to his young age, we opted against surgery and instead continued with sitz baths (performing sitz baths at least four times a day during diaper changes).
The symptoms kept recurring; the lump would sometimes resolve on its own but would reappear shortly after.
Eventually, the lump developed into an abscess.

From the initial discovery to surgery, we have been following up at this hospital.
The first surgery was performed when he was one year and three months old (on the left side of the anus), and the second surgery was at one year and five months old (on the right side of the anus).
The second surgery, a fistula operation, took place on May 31, 2019, at a hospital in Taichung (the first surgery was also at this hospital).

About two weeks post-surgery, the wound was almost healed, and during several follow-up visits, the doctors indicated that recovery was going well.
We continued with sitz baths for over a month, and as the wound healed, we reduced the frequency of the baths to only during bowel movements.
We thought we had finally reached a resolution, but recently, we noticed another abscess forming at the wound site.
The abscess breaks open on its own, and pus drains out, but it keeps recurring.

I would like to ask the doctor if this situation requires another surgical intervention (as we were informed that the recurrence rate post-surgery is low, yet it has recurred) or if we should continue with sitz baths and observation.
It is disheartening to have to subject my child to surgery at such a young age, and I am wondering if we should consider switching to another hospital.

Mr. Yao, 30~39 year old female. Ask Date: 2019/07/25

Dr. Ke Fangxu reply Surgery

It is likely a recurrence of a fistula.
In young children, this phenomenon can occasionally occur because most cases are simple fistulas, resulting in a low recurrence rate after surgery.
If there have been two surgeries in a short period and recurrence still occurs, it is advisable to start with warm sitz baths.
If necessary, antibiotic treatment can be combined.
If symptoms persist without improvement, it is recommended to consult a hospital and seek treatment from a specialist in colorectal surgery or pediatric surgery.

Reply Date: 2019/07/25

More Info

Post-surgery care for pediatric anal fistula can be quite challenging, especially when complications such as abscess formation occur. It’s understandable that as a parent, you feel concerned about your child's health and the repeated need for surgical interventions. Here’s a comprehensive overview of what you should consider regarding your child's condition and when to seek further treatment.

Understanding the Condition
Anal fistulas in children often develop from previous infections or abscesses in the anal region. They can lead to persistent symptoms, including swelling, pain, and the formation of pus-filled lumps (abscesses). The fact that your child has undergone two surgeries already indicates that the condition has been significant enough to warrant surgical intervention. However, the recurrence of symptoms, such as the appearance of new abscesses, suggests that the fistula may not have been completely resolved or that new issues have arisen.

When to Seek Further Treatment
1. Persistent Symptoms: If your child continues to develop abscesses or if the existing abscesses do not heal completely, it is crucial to consult with a pediatric surgeon. Recurrence of symptoms after surgery can indicate that the fistula has not been adequately addressed, or there may be additional fistulas that have formed.

2. Increased Pain or Discomfort: If your child exhibits signs of increased pain, discomfort, or any changes in bowel habits, these could be indicators that further evaluation is necessary.
3. Fever or Signs of Infection: If your child develops a fever or shows other signs of systemic infection (such as lethargy, irritability, or decreased appetite), it is essential to seek immediate medical attention.

4. Worsening Condition: If the abscesses become larger, more frequent, or if there is any drainage that appears abnormal (such as foul-smelling or bloody), this warrants a visit to the healthcare provider.

Treatment Options
- Continued Observation: In some cases, if the abscesses are small and not causing significant discomfort, your healthcare provider may recommend continued observation and conservative management, such as warm sitz baths (which you have been doing) to promote healing.

- Surgical Intervention: If the abscesses recur frequently or if there is a suspicion of a more complex fistula, further surgical intervention may be necessary. This could involve a more extensive procedure to ensure that all fistulous tracts are identified and treated.

- Consultation with Specialists: If you feel that your child’s condition is not improving or if you have concerns about the treatment plan, seeking a second opinion from another pediatric surgeon or a specialist in pediatric colorectal surgery may provide additional insights and options.

Emotional and Psychological Considerations
It’s completely normal to feel overwhelmed and distressed by your child’s repeated health issues. The emotional toll on both you and your child can be significant. It’s important to provide emotional support to your child and to communicate openly about their feelings. Engaging with support groups or counseling services can also be beneficial for parents dealing with chronic health issues in their children.

Conclusion
In summary, while it is common for anal fistulas to recur, persistent symptoms should not be ignored. Regular follow-ups with your healthcare provider are essential to monitor your child's condition. If you have concerns about the effectiveness of the current treatment or if your child continues to experience issues, do not hesitate to seek further evaluation or a second opinion. Your child's health and well-being are paramount, and ensuring they receive the best possible care is your priority as a parent.

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