Management of Crohn's Anal Strictures: The Experience of a Department of Medicine

Abstract

Original Research ArticleCrohn's disease is a chronic inflammatory disorder of the gastrointestinal tract. Perineal manifestations are a marker for disease severity. Anal strictures result from fibrotic scarring after several inflammatory attacks and are responsible for impaired quality of life. The aim of our work is to study the epidemiological profile and the management of these lesions. Methods: This is a descriptive retrospective study over a 17-year period from January 2002 to January 2019, concerning a monocentric cohort of 1053 cases of Crohn's disease. Results: 22 patients had anal stricture, a prevalence rate of 2.08%. The main symptoms were painful passing of stools in all patients, emission of pus in 12 patients (54.5%) cases, imperiosity in 5 patients (22.7%), abdominal pain in 10 patients (45.4%) and an obstructed defecation syndrome in 3 patients (13.6%). Penetrating phenotype B3 and the colonic localization L2 were the most frequent. Pelvic MRI confirmed anal stenosis in all patients, associated with complex fistulas PARKS grade 4 in 18% (n = 4) cases. Treatment of the stenosis consisted of finger dilatation in 21 patients (90%), associated with dilation by Hegar dilatators in 63.6% (n = 14) cases and by balloon in 31.8% (n = 7) cases; the stenosis biopsy revealed squamous cell carcinoma in only one case, 4.5%. Medical treatment for CD was based on immunosuppressants in 72.7% (n = 16) cases, anti TNF in 18.18% (n = 4) cases and Combination therapy in 9% (n = 2) cases. Conclusion: The prevalence of anal strictures in our study remains low compared to literature series; these are young women with LAP, a Penetrating phenotype and pancolitis.