Management of perianal Crohn's disease

Pescatori, Mario; Interisano, A.; Basso, L.; Arcanà, F.; Buffatti, P.; Bella, F Di; Doldi, Alessandro; Forcheri, V.; Gaetini, R.; Pera, A.; Mattana, Claudio; Prantera, Cosimo; Pulvirenti, Andrea; Segre, Diego; Simi, M; Tonelli, Francesco

doi:10.1007/bf02052437

Cited by 48 publications

(10 citation statements)

References 12 publications

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“…However, certain APCD lesions are both physically and socially disabling (i.e. drainage of malodorous secretions, perineal discomfort and pain, difficulties with hygiene, dyspareunia, and incontinence) [5], associated with a high recurrence rate [8,13], and are responsible for prolonged morbidity and numerous surgical procedures. Some patients with severe APCD lesions which are resistant to conservative treatment, require APR with definitive end ileostomy.…”

Section: Discussionmentioning

confidence: 99%

Long‐term results of faecal diversion for refractory perianal Crohn’s disease

et al. 2001

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Faecal diversion for anoperineal Crohn's disease produced a high initial rate of anoperineal lesion healing. After long-term follow-up, results of faecal diversion are good (normal bowel continuity was restored in 89%) in patients without associated rectal lesions. However, in patients with associated rectal lesions, the prospects for restoring continuity were limited, thus making faecal diversion a questionable procedure.

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Section: Discussionmentioning

confidence: 99%

Long‐term results of faecal diversion for refractory perianal Crohn’s disease

et al. 2001

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“…Ten to thirty per cent of patients suffering from Crohn's disease (CD) develop an ano‐perineal fistula 1 . Treatment of this complication is complex and the functional outcome is often disappointing.…”

Section: Introductionmentioning

confidence: 99%

Long‐term healing of Crohn's anal fistulas with fibrin glue injection

Vitton¹,

Gasmi²,

Barthet³

et al. 2005

Aliment Pharmacol Ther

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SUMMARYBackground: Injecting fibrin glue has proved to be an effective means of treating anal fistulas (AF). There has been some debate, however, as to whether this technique should be used on the AF often involved in Crohn's disease (CD). Aim: To assess the effectiveness of injecting heterologous fibrin glue as a means of treating AF refractory to immunosuppressive treatment in patients with CD. Methods: Fourteen CD patients (five men and nine women, average age 42 years) presenting with refractory AFs were included in this study. Heterologous fibrin glue was injected into the fistula tract under general anaesthesia under continuous endosonographic monitoring using a 7.5-MHz blind linear probe. The patients were followed up clinically and ultrasonographically for 3 months after the procedure, and then at regular intervals.

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“…For patients with abscesses and strictures, most authors recommend performing an imaging study, particularly for patients who fail to respond to medical or surgical treatment and for patients suffering from anal incontinence [11,12]. This recommendation could be extended to all secondary lesions, even simple ones, because of the potential for progression, diagnostic difficulties, and severity of functional outcomes [13][14][15]. Imaging studies help to assess the anatomic extent of suppurating lesions (fistulous tracts and diverticula), the anatomy of the sphincter, and the appearance of the rectal wall.…”

Section: -Imaging Of Apl In CDmentioning

confidence: 99%

Anoperineal lesions in Crohn’s disease: French recommendations for clinical practice

et al. 2017

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MRI is recommended for complex secondary lesions, particularly after failure of previous medical and/or surgical treatments. For severe anal ulceration in Crohn's disease, maximal medical treatment with anti-TNF agent is recommended. After prolonged drainage of simple anal fistula by a flexible elastic loop or loosely tied seton, and after obtaining luminal and perineal remission by immunosuppressive therapy and/or anti-TNF agents, the surgical treatment options to be discussed are simple seton removal or injection of the fistula tract with biological glue. After prolonged loose-seton drainage of the complex anal fistula in Crohn's disease, and after obtaining luminal and perineal remission with anti-TNF ± immunosuppressive therapy, surgical treatment options are simple removal of seton and rectal advancement flap. Colostomy is indicated as a last option for severe APL, possibly associated with a proctectomy if there is refractory rectal involvement after failure of other medical and surgical treatments. The evaluation of anorectal stenosis of Crohn's disease (ARSCD) requires a physical examination, sometimes under anesthesia, plus endoscopy with biopsies and MRI to describe the stenosis itself, to identify associated inflammatory, infectious or dysplastic lesions, and to search for injury or fibrosis of the sphincter. Therapeutic strategy for ARSCD requires medical-surgical cooperation.

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Management of perianal Crohn's disease

Abstract: Limited surgeries seem to achieve satisfactory results in more than one-half of the patients affected by perianal Crohn's lesions, whereas medical treatment alone is curative in a small portion of them.

Cited by 48 publications

References 12 publications

Long‐term results of faecal diversion for refractory perianal Crohn’s disease

Long‐term results of faecal diversion for refractory perianal Crohn’s disease

Long‐term healing of Crohn's anal fistulas with fibrin glue injection

Anoperineal lesions in Crohn’s disease: French recommendations for clinical practice

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