The role of pelvic MRI in assessment of combined surgical and Infliximab treatment for perianal Crohn's disease

Abstract

In patients with PACD, pelvic MRI before and after IFX treatment is an important diagnostic tool to asses fistula tract localisation, reveal abscess, planning adequate treatment approach and assess the effect of treatment. Surgical decision to remove seton was in accordance with MRI criteria for remission in PACD.

Systematic review of surgical interventions for Crohn's anal fistula

“…A summary of study characteristics is shown in Table  1, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75.…”

“…The details of the procedure and perioperative care were clear. In studies reporting the use of setons, some issues arose around the timing of removal, whether setons were removed or not, and the timing and nature of concurrent medical therapy15 17.…”

“…Seton therapy combined with anti‐TNFα therapy was the focus of two retrospective cohort studies17 20 and one prospective cohort study15, accounting for a total of 116 patients. There was incomplete characterization of group demographics.…”

“…The timing of anti‐TNFα therapy in relation to sepsis drainage or seton insertion was not clear in these studies. Short‐term success was defined as absence of drainage in two studies15 17 (although the time point for measurement was unclear) and complete fistula healing in one20. These outcomes were achieved in 46 per cent15, 53 per cent17 and 79 per cent20 of patients.…”

“…Short‐term success was defined as absence of drainage in two studies15 17 (although the time point for measurement was unclear) and complete fistula healing in one20. These outcomes were achieved in 46 per cent15, 53 per cent17 and 79 per cent20 of patients. Recurrence rates, where reported, were between 9 and 28 per cent15 20.…”