Pediatric perianal abscesses represent a frequent yet underrecognized condition that poses diagnostic and therapeutic challenges due to tissue fragility and age-dependent healing dynamics. This review synthesizes current evidence on the epidemiology, pathophysiology, and management of pediatric perianal abscesses to provide a conceptual basis for clinical decision-making. Surgical interventions such as incision and drainage offer rapid symptom relief but may increase the risk of fistula formation, particularly in older children. In contrast, conservative strategies including antibiotic therapy and observation are often effective in infants and young children, reflecting their superior regenerative capacity. Age-related differences in immune response, microbiota composition, and glandular anatomy contribute to variations in disease progression and healing outcomes. By integrating data from recent studies and clinical guidelines, this review highlights the importance of individualized, age-specific management to optimize recovery, minimize recurrence, and prevent fistula development. Furthermore, it identifies gaps in current evidence and underscores the need for standardized treatment protocols and future research into predictive and microbiome-related factors influencing disease course.

Gastrointestinal tuberculosis (TB) is an uncommon form of extrapulmonary TB, with anorectal involvement representing an exceedingly rare subset. We report a fatal case of disseminated anorectal TB in a 28-year-old male immigrant from Kenya with a history of alcohol use disorder, a recognized risk factor for TB reactivation and spread. The patient initially presented with rectal pain and perirectal purulent discharge. On evaluation, he was found to have a left perirectal abscess, a right ischioanal abscess, and multiple fistulas. Acid-fast bacillus staining of debrided anorectal abscess fluid revealed Mycobacterium tuberculosis complex, with additional evidence of pulmonary involvement on chest imaging and bronchoalveolar lavage, consistent with disseminated TB. The patient was initiated on anti-TB treatment with rifampin, isoniazid, pyrazinamide, and ethambutol. However, his condition rapidly deteriorated as he developed acute respiratory distress syndrome and septic shock, ultimately resulting in his death. This case highlights the rarity and potential severity of anorectal TB in disseminated disease. We also emphasize the importance of considering TB in patients with persistent or atypical anorectal infections, particularly those with epidemiologic risk factors such as prior residence in TB-endemic regions and alcohol use disorder.

Postoperative wound healing, especially after anal-fistula surgery, poses unique clinical challenges due to the complex anal anatomy and the need for accelerated recovery. Although the ethnomedicinal plant Cayratia japonica (Thunb.) Gagnep. has long been recognized for its wound-healing properties, its molecular basis and therapeutic potential remain poorly defined. Here, an optimized C. japonica hydrogel (CJH) markedly improved clinical outcomes, while temporal multi-omics profiling underscored the necessity of stage-specific therapeutic adaptation. Specifically, CJH-derived Luteolin 7-glucuronide was found to enhance fibroblast proliferation via BMP4 protein engagement and downstream signaling activation, thereby accelerating wound remodeling.

Background and Objectives: Biologic agents have emerged as the most important therapeutic weapon in the treatment of Crohn's disease (CD). The aim of this study is to describe the population of patients who received different molecules as first-line therapy and their persistence on first-line therapy. Materials and Methods: 622 patients from six gastroenterology departments from Bucharest, Iasi and Cluj treated between 2006 and 2024 were included in the study. A total of 87 (14%) were excluded because they received only mesalazine. A total of 535 were included in the final analysis. The main outcomes were clinical response and remission at 12 weeks of treatment and serious adverse events. Results: Three groups of patients were identified based on the first-line treatment: 45% of patients received adalimumab, 40% were treated with infliximab, and in 12.6% ustekinumab was given. Regarding the clinical and demographic characteristics, there are significant differences among the three patient groups in terms of age, disease extent, disease phenotype, proportion of individuals with perianal fistulas, clinical severity and the proportion of patients who underwent surgery. Median therapy duration was 48 months (6 ÷ 330). The three biologics studied (adalimumab, infliximab and ustekinumab) had a similar rate of clinical remission of 80%, the non-response rate also being similar (6.5%), but persistence on therapy at 2 years was better for adalimumab (66%) and infliximab (60%) compared to ustekinumab (45%) (p = 0.06). Serious adverse events leading to therapy discontinuation were more frequent in those treated with infliximab (10%) compared to adalimumab (3%) and ustekinumab (6%) (p = NS). Conclusions: There were significant baseline differences between the treatment groups, so this study represents an unadjusted comparison between the results obtained with different biologics in first-line treatment for Crohn's disease. All three biological agents used in real life for Crohn's disease therapy show similar efficacy, with an early clinical remission rate of approximately 80% and a non-response rate of 6.5%.

Background/Objectives: Very early onset inflammatory bowel disease (VEO-IBD), frequently associated with monogenic defects, is increasingly recognized worldwide but remains poorly characterized in Vietnam. This study aimed to characterize the clinical phenotypes and genetic spectrum of Vietnamese children with VEO-IBD. Methods: We conducted a retrospective cohort study at a tertiary pediatric referral center in Vietnam from July 2016 to January 2026. Clinical, laboratory, endoscopic, histopathological, genetic, and treatment data were systematically collected and analyzed. Monogenic variants were identified using next-generation sequencing and classified according to ACMG criteria. Results: Thirty-six children were included, with a median age at onset of 7.5 months, and 72.2% presenting before 24 months. Crohn's disease predominated (72.2%). Disease burden was high, with growth impairment in 75.0% and anemia in 91.7%. Extraintestinal manifestations were frequent, particularly recurrent infections (72.2%), dermatitis (44.4%), and oral ulcers (44.4%). Perianal disease occurred in 58.3%, with early complications including perianal ulcer (44.4%), perianal abscess (30.6%) and fistulas (33.3%). Inflammatory markers were markedly elevated, and disease activity indices indicated moderate-to-severe disease at diagnosis. Genetic testing was performed in 91.7% of patients, identifying monogenic etiologies in 30.3%. Identified variants involved genes related to immune regulation (IL10RA/IL10RB, FOXP3, XIAP), autoinflammation (TNFAIP3), host defense (CYBB), and epithelial function (MYO5B). Conclusions: Monogenic etiologies account for a substantial proportion of VEO-IBD and are associated with distinct clinical phenotypes and therapeutic implications. Early integration of genomic testing with clinical phenotyping is essential to improve diagnostic precision and enable pathway-based treatment, supporting precision medicine in pediatric IBD.

Non-healing perineal wounds (NHPWs), including persistent presacral sinuses, remain a common and morbid complication after elective intersphincteric proctectomy (ISP) for fistulizing perianal Crohn's disease (pCD), with reported healing rates of approximately 70% at 1 year. These complications significantly impair quality of life and increase healthcare utilization, highlighting the importance of prevention. This narrative review summarizes contemporary evidence and expert practice to present ten pragmatic strategies to reduce perineal wound dehiscence after ISP for pCD. Prevention begins with comprehensive preoperative optimization, including correction of malnutrition and anemia, minimization of corticosteroid exposure, smoking and nicotine cessation, and optimization of relevant medical comorbidities. Careful assessment and control of Crohn's disease activity are emphasized through current disease staging, proactive therapeutic drug monitoring, and aggressive surgical control of perianal sepsis. These measures often involve repeated examinations under anesthesia, drainage of abscesses and fistula tracts, fecal diversion when indicated, and selective use of hyperbaric oxygen therapy to improve local conditions before definitive surgery. Operative strategies focus on technical decisions that minimize perineal wound burden and promote healing. Key elements include performing proctectomy in the intersphincteric plane with total mesorectal excision when feasible, meticulous debridement and management of fistula tracts, and robust multilayered perineal closure. Adjunctive techniques such as horizontal mattress suturing of the levators to enhance tissue apposition, use of pedicled omental flaps with fluorescence angiography to confirm perfusion, and prophylactic incisional negative pressure wound therapy are highlighted. Collectively, these strategies provide a practical framework to reduce perineal wound complications after ISP for pCD.

Perianal fistulizing Crohn's disease (PFCD) is a severe and complex manifestation associated with high morbidity and limited treatment durability. Ustekinumab is a monoclonal antibody targeting the interleukin-12/23 pathway, which is involved in the pathogenesis of PFCD. Evidence from post hoc analyses and real-world studies has shown the therapeutic potential of ustekinumab in both anti-tumor necrosis factor-experienced and selected biologic-naïve patients with PFCD. Preliminary evidence has indicated that the treatment effect may be improved when used in combination with surgical interventions such as seton placement or sphincter-preserving procedures. Adjunctive antibiotics during induction and early monitoring of clinical and radiologic response may further enhance outcomes. While ustekinumab is increasingly being incorporated into multidisciplinary PFCD management, prospective fistula-specific trials are needed to clarify its optimal positioning. Future research should also focus on predictive biomarkers and treatment algorithms to support personalized and durable care.

Crohn's disease can present with atypical and isolated manifestations, contributing to diagnostic delays. We describe a 45-year-old woman undergoing routine colorectal cancer screening who was found to have a 30-40 mm rectal polypoid lesion and a persistent perianal abscess later identified as a fistula. Endoscopic appearance suggested segmental disease, and histopathology revealed granulomatous chronic colitis. Infectious etiologies were excluded. This case highlights an unusual presentation of Crohn's disease and emphasizes the importance of considering inflammatory bowel disease in persistent perianal disease to prevent misdiagnosis and treatment delays.