Narrative review on pediatric perianal abscess management and fistula risk

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Frontiers in Medicine Published May 15, 2026 Medically reviewed May 15, 2026 DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider age-specific management for pediatric perianal abscesses due to variable healing and fistula risk.

This is a narrative review of management strategies for pediatric perianal abscesses. The scope covers surgical interventions such as incision and drainage and conservative strategies including antibiotic therapy and observation.

The authors synthesize that surgical interventions provide rapid symptom relief. However, they report an increased risk of fistula formation with surgical interventions in older children. Healing outcomes show variations based on age-related differences.

The review identifies gaps in current evidence as a key limitation. It does not report specific sample sizes, follow-up durations, or comparative effect sizes.

The authors suggest that practice relevance involves individualized, age-specific management to optimize recovery, minimize recurrence, and prevent fistula development. They caution that the evidence does not establish causation and that outcomes may be surrogate rather than clinical.

The narrative review does not provide pooled effect sizes or trial-level data, and it does not describe a study population or adverse events beyond the noted fistula risk.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Pediatric perianal abscesses represent a frequent yet underrecognized condition that poses diagnostic and therapeutic challenges due to tissue fragility and age-dependent healing dynamics. This review synthesizes current evidence on the epidemiology, pathophysiology, and management of pediatric perianal abscesses to provide a conceptual basis for clinical decision-making. Surgical interventions such as incision and drainage offer rapid symptom relief but may increase the risk of fistula formation, particularly in older children. In contrast, conservative strategies including antibiotic therapy and observation are often effective in infants and young children, reflecting their superior regenerative capacity. Age-related differences in immune response, microbiota composition, and glandular anatomy contribute to variations in disease progression and healing outcomes. By integrating data from recent studies and clinical guidelines, this review highlights the importance of individualized, age-specific management to optimize recovery, minimize recurrence, and prevent fistula development. Furthermore, it identifies gaps in current evidence and underscores the need for standardized treatment protocols and future research into predictive and microbiome-related factors influencing disease course.