Codes

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Rectoperineal fistula – Congenital anomaly characterized by an anus that opens anterior to its normal location. The displaced anus in these lesions is usually stenotic.
• Fistula in ano – Abnormal tract connecting the anal canal to the skin around the anus that presents as a firm or fluctuating, tender mass near the anus. When found in infants, this pathology occurs almost exclusively in males.
• Anal fissure – Small tear in the rectal mucosa that is a common complication of constipation in infants and most often identified in the posterior midline of the anus. This lesion can be mistaken for a partial perineal groove, but fissures are most often associated with blood-streaked stools and crying with defecation.
• Diaper dermatitis – In severe cases, erosions or ulcers may be seen (Jacquet erosive diaper dermatitis).
• Trauma / sexual abuse – This must be considered for any infant presenting with lesions to the perineum. Perineal groove is limited to the midline of the perineal sulcus and has regular margins with no evidence of healing or other associated injuries or scars.
• Perianal streptococcal infection
• Lichen sclerosus

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References

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