Anal Pathology in Patients With Crohn's Disease

Abstract

Background: A distinctive feature of patients suffering from Crohn's disease is a predisposition to develop a variety of anal complications. The aetiology of such conditions is unclear, and the reported incidence of anal involvement in Crohn's disease varies party due to the various criteria used for classification. This study aims to review the management of patients with symptomatic anal pathology associated with Crohn's disease at St Vincent's Hospital, Melbourne. Methods: A database of 306 patients with Crohn's disease referred to the department between January 1978 and October 1994 was reviewed to identify those patients with symptomatic anal disease. The anal pathology was recorded and classified. Demographic data and the clinical and surgical history of the patient were recorded. Results: Of the 306 patients with Crohn's disease, 129 (42.4%) were identified as having symptomatic anal pathology. Patients were likely to present with anal symptoms after they had been diagnosed as having intestinal Crohn's disease (46.1 %). The commonest presentations were perianal abscess (29.5%), anal fissure (27.6%), and low anal fistula (26.7%). A minority of patients presented with highkomplex anal fistulae (3.8%), or recto-vaginal fistulae (5.2%). Five per cent of patients had Crohn's disease localized to the anal area. The pattern of intestinal disease in the remaining patients was small bowel 21.1%. small bowel and colon 31.9%, and colon 43.0%. A total of 244 local anal surgical procedures were performed on these patients; the commonest of these were drainage of an abscess (38.5%), examination under anaesthetic (29.1%). and laying open of a low anal fistula (22.5%). Following surgical treatment, the recurrence rate for perianal abscesses was 13%, and for low anal fistulae 6%. Conclusions: The majority of patients with Crohn's disease who develop anal pathology have an excellent prognosis. A minority of patients develop complex anal fistulae and these remain a therapeutic challenge.

Efficacy of Topical Metronidazole (10 Percent) in the Treatment of Anorectal Crohn's Disease

“…1-3 Isolated anorectal disease is reported in 3 to 5 percent of Crohn's patients and is found in conjunction with colorectal or enteric disease in onethird to one-half of Crohn's patients. [4][5][6][7] In spite of previous reports of the painless nature of anorectal Crohn's disease, our experience is that the condition can be inordinately painful because of deeply eroding fissures, edematous skin tags, and painful induration of the perianal region. Diagnosis of Crohn's disease after anorectal surgery is particularly problematic because of protracted postoperative pain, induration, and discharge.…”

Nifedipine Gel with Lidocaine in the Treatment of Anal Fissure in Children: A Pilot Study and Review of the Literature

“…Crohn's disease: Platell et al (1996) noted symptomatic anal pathology in 42.4% of Crohn's disease patients, 27.6% of them presenting anal fissures. Frequently, they are multiple or off the midline, and often coexist with other pathology (Sangwan et al, 1996).…”

An Evaluation of Vaginal Symptoms in Women with Crohn’s Disease

“…Rectovaginal fistulas occur in approximately 5-10% of women with Crohn's disease, and occur more commonly in patients with rectal involvement of Crohn's disease [7,8]. The etiology of the fistula formation is thought to be either from crypt infection or from a complication of an anal fissure or ulcer [7][8][9][10].…”