Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial to improve outcomes.

It is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time.

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Background:The most frequent tumor of the anal region is epidermoid carcinoma; however, other types of tumors such as melanomas, sarcomas, and lymphomas can also develop. Most of them present similar symptoms although diagnosis and prognosis might be radically different. Objective: The objective of this study was to report the clinical and histopathological characteristics of a group of patients diagnosed with non-epidermoid anal neoplasm in a third-level hospital. Materials and Methods: Eight patients with non-epidermoid anal neoplastic biopsy samples were evaluated from March 2013 to January 2017. Demographic data and histopathological results were obtained from the clinical records. Results: Mean age of the patients was 48.9 years (23-84); 37.5% of women and 62.5% of men. Patients presented with rectal bleeding in 25%, anal pain 87.5%, anal tumor 75%, and fever 25%. Among the patients, 37.5% presented with melanoma and 62.5% lymphoma. Regarding patients with lymphoma, 60% had plasmablastic lymphoma and 40% non-Hodgkin's lymphoma. The diagnostic time was 4 months on average (1-8 months) and 25% of the patients had been previously misdiagnosed with hemorrhoidal disease. Conclusion: Non-epidermoid anal neoplasm cases are infrequent and its accurate diagnosis can take months, therefore, changing prognosis.