[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]

C

c

correct answer

c Fistulotomy

 

A perianal abscess that has recurred five times is highly suggestive of an underlying fistula-in-ano (FIA). In infants, most perianal abscesses resolve spontaneously, but persistent or recurrent cases often indicate an associated fistula that requires definitive treatment. Fistulotomy is the most effective intervention to eliminate the fistula tract, prevent further abscess formation, and achieve the lowest recurrence rates. While some advocate for conservative management due to the potential for spontaneous resolution, repeated recurrences can prolong morbidity and fistulotomy remains the best option for definitive treatment.