Perianal crohn’s disease

Background Perianal lesions in patients with Crohn’s disease (CD) are frequent. Methods Forty-seven patients (22 M and 25 F) with perianal CD were followed. Mean age was 39 years. Anal involvement was observed in 12.2% of patients with ileal disease, 34.2% in ileo-colic disease; 40% in patients with colonic disease and 100% of rectal Crohn’s disease. We treated 27 patients with anal fistula; 13 anal abscess; 4 anal stenosis; 4 anal fissures; 6 anal ulcerations, 5 haemorrhoids; 7 edematous skin tags and 5 patients with skin changes. Results Anal stenosis was treated successfully with dilatations. Ulcerations, edematous skin tags and skin changes were treated conservatively. Patients with an anal abscess underwent surgical drainage and were followed up for a subsequent fistula. In 2 cases of haemorrhoids, rubber bands ligations were performed with good results. Anal fissures were treated with anal dilatations. One of them healed completely, while 3 patients were submitted to a lateral internal sphincterotomy for the persistence or the recurrence of the disease with 1 minor incontinence treated with biofeedback. Anal 238 Tech Coloproctol (2011) 15:215–253 123 fistula was treated as follows: fistulotomy in 5 cases, fistulectomy in 4 cases, cutting seton in 17 cases. In 1 case, surgical treatment was associated with infliximab. Patients treated with cutting seton healed in 10 cases, in 2 cases, a new fistula occurred, while 5 patients suffered a recurrence. Patients who underwent a fistulotomy or fistulectomy healed in 7 cases and recurred in 2 cases. We observed 5 cases of soiling (3 after fistulotomy/fistulectomy and 2 after seton); and 2 cases of minor incontinence (1 after fistulectomy and 1 with cutting seton). In 1 case a, proctocolectomy was performed for a very aggressive disease with multiple anal fistulas. Conclusions Patients affected by perianal Crohn’s disease must be treated only if symptomatic and when CD in a quiescent status.