The clinical characteristics of fistula-in-ano in infants are different from those of older children, and its treatment remains controversial. We suggest that fistula-in-ano in infants has a congenital etiology. To verify this hypothesis and to settle the controversies regarding fistula-in ano in infants, a retrospective analysis of 29 patients less than 2 years of age with anal fistulae treated between 1994 and 2009 at Samsung Changwon Hospital were reviewed retrospectively. Twenty two patients were male and mean age at diagnosis was 7.2±5.2 months. Eleven out of 22 cases had previous surgical drainage for perianal abscess. 18 patients had fistulotomy (81.8%) and four had fistulectomy (18.2%). Cryptotomies with fistulectomy were performed in 10 patients (45.5%) who had involved crypt. There was one recurrence. These results suggest that fistula-in-ano in young children less than two years of age is different from those in older children or adults. Fistulotomy is suggested to be the recommended treatment of choice. A future study involving non-operative management would be required to explore all treatment options.

This is a 20 year analysis of the problems associated with enterostomy formation, and closure. Forty-three stomas were established in 43 patients: 23 for anorectal malformations, 11 for Hirschsprung's diseases, 4 for necrotizing enterocolitis, 3 for multiple ileal atresias, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. Thirty boys and 13 girls were included (mean age 4.8 months). Stoma complications were encountered in 13 patients (30.2 %): stomal prolapse, stenosis, obstruction, paracolic hernia, retraction, dysfunction, and skin excoriation. Four patients (9.3 %) required stomal revision. Occurrence of complications was not related to age and primary disease, but sigmoid colostomy showed lower complication rate than transverse colostomy (20.0 % vs 42.9 %, p<0.05). There were five deaths but, only one (2.3 %) was directly related to the enterostomy complication. Twenty-one stomas were closed in our hospital and complications occurred in seven patients (33.3 %). The most common complication was wound sepsis in 5 children. In conclusion, because the significant morbidity of stomal formation still exists, refinements of the surgical technique seem to be required. Sigmoid loop colostomy is preferred whenever possible.

Reduction of intussusception using air or oxygen has wide acceptance as an alternative to conventional hydrostatic reduction. This study was undertaken to evaluate the results and complications of air pressure enema in 948 pediatric inc tussusception. One hundred and twenty nine cases were operated on at the Department of Surgery, Masan Samsung Hospital from 1985 to 1996 because of air reduction failure. The success rate was 86.4 %. Twenty-one patients(2.2 %) showed perforation during air reduction. Risk prone factors of perforation were; age less than 3 months(42.9 % vs 11.1 %), duration of symptoms greater than 48 hours(66.7 % vs 33.3 %), and presence of pathologic leading point(28.6 % vs 3.7 %). Vomitting and spontaneous rectal bleeding revealed higher prediction to the complication. In ninteen cases, bowel infarction, coagulated necrosis and hemorrhage suggested that the cause of perforation was due to the preexisting strangulation. In conclusion, when doing an air pressure enema reduction, care must be taken if the patient is of a young age or the symptoms are of long duration.