Combination therapy with traditional medicines for perianal abscess in children

Abstract

Background: Combination therapy with two different traditional medicine formulations called hainosankyuto and juzentaihoto (TJ-122 and TJ-48; Tsumura & Co, Tokyo, Japan) may be effective for perianal abscess (PA), but their effectiveness has not been established. The present study investigated the effectiveness of combination therapy with TJ-122 and TJ-48 as the most effective conservative treatment for PA. Methods: We identified 69 patients with PA under 2 years of age and divided them into four groups according to the formulations used: group 1, TJ-122 (n = 17); group 2, TJ-48 (n = 14); group 3, TJ-122 and TJ-48 (n = 19); and group 4, no traditional medicines (n = 19). Treatment was continued for 3-6 months after resolution of the PA in groups 1 and 2, and for 1 year in group 3. Age at presentation, duration of purulent discharge (PD), frequency of surgical intervention (incision and drainage [ID]; fistulotomy/fistulectomy), and recurrence rates were statistically analyzed. Results: Mean age (months) was 8.6 AE 9.2, 6.9 AE 7.3, 5.2 AE 4.7, and 3.8 AE 3.1 in groups 1, 2, 3, and 4, respectively (P = n.s.). Mean PD (weeks) was 2.5 AE 2.2, 7.1 AE 10.8, 2.0 AE 0.0, and 2.7 AE 1.0, respectively. Duration of PD was significantly longer in group 2 than in groups 1 and 3 (P < 0.05). Mean number of ID procedures was 1.0 AE 0.2, 2.3 AE 0.5, 0, and 1.6 AE 0.2, respectively. Group 1 had significantly less ID than group 2 (P < 0.01). Recurrence rates were 6%, 36%, 0%, and 32%, respectively. Groups 1 and 3 had significantly less recurrence than group 2 (P < 0.05), and group 3 had significantly less recurrence than group 4 (P < 0.01). Conclusions: Combination therapy with TJ-122 and TJ-48 decreased recurrence and surgical intervention to zero in this study, demonstrating high effectiveness for treating PA in children.

Incision and Drainage With Primary Fistulotomy of Perianal Abscess Is Safe and Effective in Neonates: A Long-Term Follow-Up Study

“…Remarkably, in the present study, 6.5% (9/138) of patients developed new abscesses on the contralateral side of the anus. Several studies have previously reported a similar phenomenon (16,21,25,35,36), but the reason was unknown.…”

“…It has traditionally been treated surgically by incision and drainage (ID) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, in the past two decades, some studies have shown that the conservative management appears to be effective in selected cases (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). On the other hand, the other studies have recommended that the surgical procedure should involve a careful identification for the fistula and treatment of that by fistulotomy (24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Treatment of Perianal Abscess and Fistula in Infants and Young Children: From Basic Etiology to Clinical Features

“…Even if the abscess ulcers during the treatment, it can heal naturally without scarring. 32 In traditional Chinese medicine, Qingreliangxue ointment was used to treat the perianal abscess of infants, which proved that it had a good effect of effectively reducing swelling and analgesia and the local skin temperature of the abscess. 33…”

Risk factors for therapy failure after incision and drainage alone for perianal abscesses in children

“…Discussions in the medical fraternity continue to center around the management of PA in children. Both conservative treatment and surgical treatment have been reported with good outcomes ( 2 , 4 , 6 , 8 , 10 , 12 , 25 ). Surgery must be performed when an abscess is likely to spread or shows no sign of spontaneous perforation ( 4 ).…”