Abstract
Fistula in ano, a relatively common condition in infants, may lead to perianal abscess formation. Although most fistulae are isolated, some infants develop multiple abscesses. The development of fistula is thought to be the result of cryptitis and may be congenital or linked to immunodeficiency in some patients. We report 5 infants, 1½ to 6 months of age, who presented with multiple perianal abscesses. Surgical excision and antibiotic therapy was provided for all patients; however, recurrent abscesses developed. Two patients were hemoccult-positive at evaluation, 3 patients had IgE and RAST testing for milk allergy—all results were normal. Each patient underwent sigmoidoscopy and biopsy. Rectal biopsy in all patients revealed histologic evidence of eosinophilic proctitis. Accordingly, each patient was placed on a hypoallergenic formula. Table RESULTS: In all 5 patients, rapid resolution of abscess occurred and no subsequent abscess developed following placement on hypoallergenic formula (follow-up > 6 months in all patients). CONCLUSIONS: Recurrent fistulae in ano and perirectal abscess in infants may be related to allergic colitis and respond to a hypoallergenic diet. Sigmoidoscopy and biopsy should be considered in patients with multiple perirectal abscesses as part of their evaluation.
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