Correct answer
C Referral to Pediatric Gastroenterology for workup of Crohn’s Disease
This child’s presentation is highly suspicious for perianal Crohn’s Disease. This diagnosis should be considered in any school-age child or adolescent with a perianal abscess, regardless of family history. These patients should be referred to Pediatric Gastroenterology for workup of Crohn’s Disease and initiation of anti-TNF therapy. If a draining Seton was inserted at the time of the incision and drainage procedure, then this should be left in place until the patient is stabilized on a biologic medication.
Fistulotomy should be avoided in patients with possible perianal Crohn’s Disease as this can result in a chronic, non-healing wound. Observation alone is an appropriate option in an infant with a spontaneous perianal abscess, as there is no known association with Crohn’s Disease, and these lesions almost always heal without surgical intervention. The decision to start medical therapy in the absence of a definitive diagnosis of Crohn’s disease (such as starting empiric steroids) should be left to the discretion of the Pediatric Gastroenterology team.
C Referral to Pediatric Gastroenterology for workup of Crohn’s Disease
This child’s presentation is highly suspicious for perianal Crohn’s Disease. This diagnosis should be considered in any school-age child or adolescent with a perianal abscess, regardless of family history. These patients should be referred to Pediatric Gastroenterology for workup of Crohn’s Disease and initiation of anti-TNF therapy. If a draining Seton was inserted at the time of the incision and drainage procedure, then this should be left in place until the patient is stabilized on a biologic medication.
Fistulotomy should be avoided in patients with possible perianal Crohn’s Disease as this can result in a chronic, non-healing wound. Observation alone is an appropriate option in an infant with a spontaneous perianal abscess, as there is no known association with Crohn’s Disease, and these lesions almost always heal without surgical intervention. The decision to start medical therapy in the absence of a definitive diagnosis of Crohn’s disease (such as starting empiric steroids) should be left to the discretion of the Pediatric Gastroenterology team.
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