Management of Perianal Crohn's Disease

Parian, Alyssa; Obi, Megan; Fleshner, Phillip; Schwartz, David A.

doi:10.14309/ajg.0000000000002326

Cited by 21 publications

(7 citation statements)

References 109 publications

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“…Most perianal fistulas appear at or after the diagnosis of CD, but 10-30% of the time, perianal fistulas may precede the diagnosis of luminal CD. Perianal CD affects 25-35% of CD patients [ 11 ]. The pathogenesis of CD perianal fistulas is not fully understood and may originate from inflammation or infection of the anal glands in CD patients or from deep penetrating ulcers in the rectum or anus [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Perianal Mucinous Adenocarcinoma: A Case of Recurrent Anal Fistula

Chen,

2024

Cureus

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An anal fistula is a fairly common clinical condition, with a very low incidence of malignant transformation. Mucinous adenocarcinoma is a subtype of adenocarcinoma, and its occurrence within perianal fistula tracts is quite rare. This case report describes a 54-year-old male patient with recurrent anal fistula, initially suspected of Crohn's disease (CD), and ultimately diagnosed with perianal mucinous adenocarcinoma. After our joint internal medicine, surgery, and imaging reassessment, the diagnosis was confirmed. Anal fistula is usually considered a benign lesion, but it may also be associated with other diseases. Due to overlapping symptoms of related diseases, the investigation of malignant lesions is often overlooked. This case report emphasizes the importance of timely referral and multidisciplinary management for disease diagnosis and early treatment.

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Section: Discussionmentioning

confidence: 99%

Perianal Mucinous Adenocarcinoma: A Case of Recurrent Anal Fistula

Chen,

2024

Cureus

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“…To successfully manage the patient with perianal fistula, a multidisciplinary team of specialists should be established (as repeatedly emphasized in various sections of this review) to achieve remission of the bowel lumen and fistula inflammation, as well as repair of the underlying dysfunction of the fistula[ 42 ]. Perianal fistula occurs in approximately 25% of patients with CD.…”

Section: Treatment Of Perianal CDmentioning

confidence: 99%

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Triantafillidis

2024

World J Gastrointest Surg

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Treatment of ulcerative colitis (UC) and Crohn’s disease (CD) represents, in the majority of cases, a real challenge to the gastroenterologist’s abilities and skills as well as a clinical test concerning his/her levels of medical knowledge and experience. During the last two decades, our pharmaceutical arsenal was significantly strengthened, especially after the introduction of the so-called biological agents, drugs which to a large extent not only improved the results of conservative treatment but also changed the natural history of the disease. However, colectomy is still necessary for some patients with severe UC although smaller compared to the past, precisely because of the improvements achieved in the available conservative treatment. Nevertheless, surgeries to treat colon dysplasia and cancer are increasing to some extent. At the same time, satisfactory improvements in surgical techniques, the pre-and post-operative care of patients, as well as the selection of the appropriate time for performing the surgery have been noticed. Regarding patients with CD, the improvement of conservative treatment did not significantly change the need for surgical treatment since two-thirds of patients need to undergo surgery at some point in the course of their disease. On the other hand, the outcome of the operation has improved through good preoperative care as well as the wide application of more conservative surgical techniques aimed at keeping as much of the bowel in situ as possible. This article discusses the indications for surgical management of UC patients from the gastroenterologist’s point of view, the results of the emerging new techniques such as transanal surgery and robotics, as well as alternative operations to the classic ileo-anal-pouch anastomosis. The author also discusses the basic principles of surgical management of patients with CD based on the results of the relevant literature. The self-evident is emphasized, that is, to achieve an excellent therapeutic result in patients with severe inflammatory bowel disease in today’s era; the close cooperation of gastroenterologists with surgeons, pathologists, imaging, and nutritionists is of paramount importance.

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“…These findings can influence treatment decisions such as indication for EUA, optimizing anti-TNF therapy, and determining an optimal time for seton removal [40]. Recent guidance from the European Crohn's and Colitis Organization and American College of Gastroenterology both support the use of rEUS in these capacities [41,42]. Despite this support, there has not been much data published in the last few years evaluating this technique.…”

Section: Peri-anal Crohn's Diseasementioning

confidence: 99%

Interventional inflammatory bowel disease: current and future practice

Clement,

Reyes Genere

2024

Current Opinion in Gastroenterology

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Purpose of review Inflammatory bowel diseases (IBD) are associated with several well described neoplastic and structural complications. Increasing disease prevalence, healthcare barriers, and medication refractory phenotypes contribute to ongoing complications despite significant strides in medical management. Enhancements in endoscopic technology and techniques have allowed a minimally invasive approach for what has historically required surgery. In this article, we review the current and future landscape of endoscopic IBD intervention. Recent findings Endoscopic resection is the first line for managing conventional and complex colitis-associated dysplasia. Evidence supporting endoscopic submucosal dissection is mounting, yet there is a paucity of studies evaluating modified endoscopic mucosal resection techniques or hybrid endoscopic submucosal dissection. We also have more clarity in how best to approach fibrostenotic disease, as we learn how to position endoscopic stricturotomy and stenting, relative to balloon dilation. Finally, applications in managing penetrating and postsurgical complications have been described, but still require further study. Summary While important knowledge gaps still exist, the application of endoscopic therapies in IBD is more refined, especially within the management of colitis-associated dysplasia and strictures. The indications for endoscopy in perianal disease and other penetrating manifestations of Crohn's disease presents exciting opportunities for growth.

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Management of Perianal Crohn's Disease

Cited by 21 publications

References 109 publications

Perianal Mucinous Adenocarcinoma: A Case of Recurrent Anal Fistula

Perianal Mucinous Adenocarcinoma: A Case of Recurrent Anal Fistula

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Interventional inflammatory bowel disease: current and future practice

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