Diagnosis and Treatment of Perianal Crohn Disease

Abstract

Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract that includes both Crohn disease (CD) and ulcerative colitis. Abdominal pain, rectal bleeding, diarrhea, and weight loss characterize both CD and ulcerative colitis. The incidence of IBD in the United States is 70 to 150 cases per 100,000 individuals and, as with other autoimmune diseases, is on the rise. CD can affect any part of the gastrointestinal tract from the mouth to the anus and frequently will include perianal disease. The first description connecting regional enteritis with perianal disease was by Bissell et al in 1934, and since that time perianal disease has become a recognized entity and an important consideration in the diagnosis and treatment of CD. Perianal Crohn disease (PCD) is defined as inflammation at or near the anus, including tags, fissures, fistulae, abscesses, or stenosis. The symptoms of PCD include pain, itching, bleeding, purulent discharge, and incontinence of stool. In this report, we review and discuss the etiology, diagnosis, evaluation, and treatment of PCD.

Diagnosis and management of inflammatory bowel disease in children

“…85 Clinical reports and consensus statements are also available from NASPGHAN for long term health supervision, management of pediatric Crohn's disease with perianal manifestations and penetrating phenotype, and approach to infectious diseases in children receiving antitumor necrosis factor-α (TNF-α) drugs. [86][87][88] Induction therapy Exclusive enteral nutrition Exclusive enteral nutrition (EEN) can be used for six to eight weeks to induce remission in patients with a new diagnosis or an acute flare of the disease. Evidence shows that elemental formulas are not superior to polymeric formulas, supporting the use of such formulas, which are less expensive and more palatable.…”

Draft recommendations of the russian society of pediatric gastroenterology, hepatology and nutrition on diagnosis and treatment of Crohn's disease in children

“…Данный раздел подготовлен на основе данных литературы, доказательного консенсуса по лечению детей с БК и клинических рекомендаций международных и национальных Обществ детских гастроэнтерологов, гепатологов и нутрициологов -Европейского [2], Британского [143] и Североамериканского [144], а также на основе доказательного консенсуса Всемирной Организации Здравоохранения по лечению ВЗК [4] и лечению перианальной формы БК [145]; клинических рекомендаций по лечению взрослых пациентов с БК -Европейских [146,147] и Российских Ассоциаций колопроктологов и гастроэнтерологов [8].…”

Surgery in Pediatric Crohn's Disease: Indications, Timing and Post-Operative Management

“…Simple skin incision or silastic drain can be placed according to the abscess location and size. Internal drainage from the anal canal or rectum without external skin incision is not preferred because the abscess can recur in a short time [17]. …”

“…In contrast, complex fistula or fistula to adjacent organ require surgical treatment because those lesions do not heal completely with a medical approach [17]. Because treatment strategies differ according to the type of perianal disease, thorough assessment about the lesions is necessary before treatment.…”

“…Rectal examination, endoscopic ultrasound, magnetic resonance imaging (MRI), and examination under anesthesia are usually used. Due to its high sensitivity and specificity and lack of radiation exposure, MRI is considered to be the radiologic study of choice in most cases [17]. Seton procedures, which drain inflammatory exudates from the fistula track, are frequently used and are useful for complex perianal fistula.…”