Carcinoma does arise in the midst of the anorectal fistulas and abscesses of Crohn's disease. Carcinoma arising in a Crohn's disease fistula can be very difficult to diagnose. Examination may be limited by pain, stricture, or induration of the perianal and perineal tissues. Examination under anesthesia can also overlook the lesion. Diagnostic examination under anesthesia yields increases with biopsies or curettage of the fistulous tracts.

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For the past 20 years, internal anal sphincterotomy has generally been considered to be the standard operation for an anal fissure. We sought an alternative form of treatment because of the wound complications inherent in this operation. Anal dilatation, precisely performed with a Parks' retractor opened to 4.8 cm or with a 40-mm rectosigmoid balloon, has been found to cure successfully the fissure in 93 percent and 94 percent, respectively, of each group and to be associated with fewer complications.

No abstract