Perianal abscesses in infants are not associated with Crohn's disease in a surgical cohort

BACKGROUND AND AIMS: The aim of this study is to search for an association between infantile perianal abscesses and (development of) Crohn's disease in a surgical population of children.

METHODS: Patients who were surgically treated in the Amsterdam UMC between January 2000 and December 2014 were included in this retrospective cohort study. Data collected: sex, date of birth, underlying conditions, age of onset, additional symptoms, pus cultures, endoscopic examination, histological examination, fecal calprotectin levels, antibiotic treatment, surgical treatment strategy and number of recurrences. Follow-up data were gathered from medical records and by contacting the patients and/or parents or the general practitioner.

RESULTS: The study consisted of 62 patients of which sixty boys. Median age was five months (range 0-17 months), 92% was under one year of age at diagnosis. A minority of patients had accompanying symptoms. In total 72 abscesses were treated, nineteen fistulas and 23 abscesses with an fistula-in-ano. Follow-up data of 46 patients (74%) was available; none of the patients developed Crohn's disease.

CONCLUSIONS: We found no association between isolated perianal abscesses as presenting symptom in early childhood and (development of) Crohn's disease. In young infants with isolated perianal disease risk for IBD seems low. In this specific population there seems no place for routine performance of endoscopic investigations. One should always take the risk of Very-Early-Onset Inflammatory Bowel Disease into account. Further research with a larger cohort of children and a longer follow-up time is required.