Anal fistulas in Crohn's disease

Abstract

Anal fistulas were recorded in 112 patients out of a series of 329 patients with Crohn's disease admitted to St Mark's Hospital for the first time between 1965 and 1976. Only 13 of 112 patients had small bowel disease alone. The remainder all had involvement of some part of the large bowel. There were 125 fistulas in the 112 patients. No treatment was attempted for 47 fistulas (38 per cent). Most patients had low fistulas which were treated by conventional techniques and healed successfully. Limited surgery was often successful in curing the symptoms of patients with more difficult fistulas. Anal lesions were the major reason for surgery in only a third of the patients who finally underwent excision of the return.

Management of perianal Crohn's disease

“…The apparently low incidence in the present series (33%) is explained by the omission of those patients with skin tags only. The incidence of fistula-in-ano (17%) in this series is similar to that reported by others (Fielding 1972, Hellers et al 1980, Marks et al 1981. By far the commonest fistula encountered was of the low type.…”

“…The satisfactory results of operations on low fistulae reported in this series, and by Marks et al (1981), demonstrate that local surgery can be undertaken without undue hazard. This justifies a policy of definitive surgical treatment for low fistula-in-ano in association with…”

Outcome of surgical treatment for fistula in ano in Crohn's disease

“…Crohn's disease is complicated by the development of anal fistulas in approximately one-third of patients 1,2 . The goal of fistula surgery for patients with Crohn's disease is to relieve symptoms and achieve closure in selected cases 3 ; treatment consists of abscess drainage, use of loose setons, fistulotomy and mucosal advancement 4 -6 .…”

Enterovaginal Fistula in Crohn’s Disease

“…Microscopic Crohn's disease in margins of resection is no bar to successful anastomosis [9], It is possible to treat perianal fistulas in patients with Crohn's disease in the usual radical way with good results [10,11], 'Stricture plasties' are being performed on small bowel stenosed by Crohn's disease without dire consequences [12][13][14], There thus seems to be more room for surgical interven tion than we have been taught to think. It would seem reasonable then to try local treatment more often in cases of rectovaginal fistula with mild to moderate involve ment of the rectum.…”