BACKGROUND Crohn's disease is a chronic inflammatory disease, which involves almost all parts of body. Perianal manifestations maybe the initial presentation in these patients, but usually includes other systemic manifestations along with it. This study was conducted to determine presence of perianal disease as the initial manifestation in otherwise asymptomatic Crohn's patients. MATERIALS AND METHODS This study was conducted in Department of Gastroenterology in a tertiary care hospital. All patients presenting with perianal manifestations were evaluated with colonoscopy and other imaging (in selected cases) to identify Crohn's disease. RESULTS A total of 46 patients were evaluated for perianal disease, out of which 3 patients (6.5%) had evidence of Crohn's disease in colonoscopy. Major presentation in these patients were skin tags (n=27, 58.6%), anal fissures (n=15, 32.6%) and fistula (n=4, 8.6%). The major symptoms were pain in perianal region (n=38, 82.6%), bleeding PR (n=23, 50%), anal pruritus (n=8, 17.3%) and mucus discharge PR (n=7, 15.2%). CONCLUSION Perianal disease maybe the initial presentation in Crohn's disease. Judicious evaluation of these perianal lesions helps in early diagnosis of Crohn's disease.