Perianal diseases

[size=6]A 6-month-old child presents with a perianal abscess at the 3 o’clock position that has recurred six times. What is the next best step in management? a Needle Aspiration b Warm soaks and local care c Fistulotomy d Incision and drainage (I&D)[/size]

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[size=20px]A 7-year-old boy undergoes incision and drainage of a perianal abscess. He is discharged home and completes a course of oral amoxicillin/clavulanate (Augmentin). The boy returns to your clinic 4 weeks later with a persistently draining perianal fistula at the 5 o’clock lithotomy position. He has no further pain or fevers. The most appropriate next step is: A Observation alone as the fistula will likely close spontaneously B Fistulotomy as the fistula will not likely close spontaneously C Referral to Pediatric Gastroenterology for workup of Crohn’s Disease D Empiric oral steroid therapy[/size]

[size=20px]A patient undergoes anal sphincterotomy for fistula-in-ano. To keep stool from the operative field, the surgeon packs a temporary ray-tec sponge in the rectum with the intention to remove it at the end of the case. The surgeon completes the procedure and the counts are correct. In the PACU the parents noted that there is a sponge in the diaper. The child is otherwise doing well. Federal legislation mandates reporting this event to the A Scrub nurse B Hospital Safety Committee C Divisional M and M committee D Parents E Primary care provider[/size]

A 5-year-old boy undergoes incision and drainage of a perianal abscess. He is discharged home and completes a course of oral amoxicillin/clavulanate (Augmentin). The boy returns to your clinic 4 weeks later with a persistently draining perianal fistula at the 5 o’clock lithotomy position. He has no further pain or fevers. The most appropriate next step is: A Observation alone as the fistula will likely close spontaneously B Fistulotomy as the fistula will not likely close spontaneously C Referral to Pediatric Gastroenterology for workup of Crohn’s Disease D Empiric oral steroid therapy

see video link in second post

[size=20px]A three-month old child has a recently drained perianal abscess and presents with a draining fistula at the site of the incision. What is the best next step in management of this infant with a perianal fistula? A fistulotomy B infliximab C seton placement D antibiotics E observation[/size]