Perianal Crohn's Disease

Bashar Safar; Dana Sands

doi:10.1055/s-2007-991027

Clinics in Colon and Rectal Surgery, Inhaltsverzeichnis

Clin Colon Rectal Surg 2007; 20(4): 282-293
DOI: 10.1055/s-2007-991027

Perianal Crohn's Disease

Bashar Safar¹ , Dana Sands¹

¹Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida

Abstract

ABSTRACT

Crohn's disease is commonly complicated by perianal manifestations. The surgeon plays a pivotal role in caring for these patients; a detailed history along with a thorough clinical exam provides the treating physician with invaluable information upon which to base further investigations and management decisions. Other than abscess drainage, medical management to control proximal disease often precedes any surgical attempt to cure the disease. Surgical interventions are indicated in selective patients, but are often complicated by poor wound healing and recurrences. A sizable percentage of these patients may need a proctectomy.

KEYWORDS

Crohn's disease - perianal - fistula

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Referenzen

REFERENCES

1 Crohn B B, Ginzburg L, Oppenheimer G D. Regional éleitis, a pathological and clinical entity. JAMA. 1932; 99 1323-1329
2 Penner A, Crohn B B. Perianal fistulae as a complication of regional ileitis. Ann Surg. 1938; 108 867-873
3 Sangwan Y P, Schoetz Jr D J, Murray J J, Robgrts P L, Coller J A. Perianal Crohn's disease. Results of local surgical treatment. Dis Colon Rectum. 1996; 39 529-535
4 Lockhart-Mummery H E. Symposium. Crohn's disease: anal lesions. Dis Colon Rectum. 1975; 18 200-202
5 Singh B, McC Mortensen N J, Jewell DP, George B. Perianal Crohn's disease. Br J Surg. 2004; 91 801-814
6 Hellers G, Bergstrand O, Ewerti S, Holmstrom B. Occurrence and outcome after primary treatment of`anal fistulae in Cohn's disease. Gut. 1980; 21 525-527
7 Williams D R, Coller J A, Corman M L, Nugent F W, Veidenheimer M C. Anal complications in Crohn's disease. Dis Colon Rectum. 1981; 24 22-24
8 Alabaz O, Weiss E G. Anorectal Crohn's disease. In: Beck D, Wexner SD Fundamentals of Anorectal Surgery. 2nd ed. Philadelphia, PA; WB Saunders 1999: 498-509
9 Hughes L E. Surgical pathology and management of anorectal Crohn's disease. J R Soc Med. 1978; 71 644-651
10 Hughes L E. Clinical classification of perianal Crohn's disease. Dis Colon Rectum. 1992; 35 928-932
11 Irvine E J. Usual therapy improves perianal Crohn's disease as measured by a new disease activity index. McMaster IBD Study Group. J Clin Gastroenterol. 1995; 20 27-32
12 Pikarsky A J, Gervaz P, Wexner S D. Perianal Crohn disease: a new scoring system to evaluate and predict outcome of surgical intervention. Arch Surg. 2002; 137 774-777 discussion 778
13 Schwartz D A, Wiersema M J, Dudiak K M et al.. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulae. Gastroenterology. 2001; 121 1064-1072
14 Person B, Wexner S D. Management of perianal Crohn's disease. Curr Treat Options Gastroenterol. 2005; 8(3) 197-209
15 Keighley M R, Allan R N. Current status and influence of operation on perianal Crohn's disease. Int J Colorectal Dis. 1986; 1 104-107
16 Sandborn W J, Fazio V W, Feagan B G, Hanauer S B. American Gastroenterological Association Clinical Practice Committee. AGA technical review on perianal Crohn's disease. Gastroenterology. 2003; 125(5) 1508-1530
17 Jeffery P J, Parks A G, Ritchie J K. Treatment of haemorrhoids in patients with inflammatory bowel disease. Lancet. 1977; 1 1084-1085
18 Wolkomir A F, Luchtefeld M A. Surgery for symptomatic hemorrhoids and anal fissures in Crohn's disease. Dis Colon Rectum. 1993; 36 545-547
19 Fleshner P R, Schoetz Jr D J, Roberts P L, Murray J J, Coller J A, Veidenheimer M C. Anal fissure in Crohn's disease. A plea for aggressive management. Dis Colon Rectum. 1995; 38 1137-1143
20 Sweeney J L, Ritchie J K, Nicholls R J. Anal fissure in Crohn's disease. Br J Surg. 1988; 75 56-57
21 Makowiec F, Jehle E C, Becker H D, Starlinger M. Perianal abscess in Crohn's disease. Dis Colon Rectum. 1997; 40 443-450
22 Parks A G, Gordon P H, Hardcastle J D. A classification of fistula-in-ano. Br J Surg. 1976; 63 1-12
23 West R L, Van der Woude C J, Endtz H P et al.. Perianal fistulae in Crohn's disease are predominantly colonized by skin flora: implication for antibiotic treatment. Dig Dis Sci. 2005; 50 1260-1263
24 Bernstein L H, Frank M S, Brandt L J, Boley S J. Healing of perineal Crohn's disease with metronidazole. Gastroenterology. 1980; 79 357-365
25 Brandt L J, Bernstein L H, Boley S J, Frank M S. Metronidazole therapy for perineal Crohn's disease: a follow-up study. Gastroenterology. 1982; 83 383-387
26 West R L, Van der Woude C J, Hansen B E et al.. Clinical and endosonographic effect of ciprofloxacin on treatment of perianal fistulae in Crohn's disease with infliximab: a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2004; 20(11-12) 1329-1336
27 Present D H, Korelitz B I, Wisch N, Glass J L, Sachar D B, Pasternack B S. Treatment of Crohn's disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med. 1980; 302 981-987
28 Pearson D C, May G R, Fick G H, Sutherland L R. Azathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Ann Intern Med. 1995; 123 132-142
29 Lecomte T, Contou J F, Beaugerie L et al.. Predictive factors of response of perianal Crohn's disease to azathioprine or 6-mercaptopurine. Dis Colon Rectum. 2003; 46 1469-1475
30 Present D H, Lichtiger S. Efficacy of cyclosporine in treatment of fistula of Crohn's disease. Dig Dis Sci. 1994; 39 374-380
31 Sandborn W J, Present D H, Isaacs K L et al.. Tacrolimus for the treatment of fistulae in patients with Crohn's disease: a randomized, placebo-controlled trial. Gastroenterology. 2003; 125 380-388
32 Present D H, Rutgeerts P, Targan S et al.. Infliximab for the treatment of fistulae in patients with Crohn's disease. N Engl J Med. 1999; 340 1398-1405
33 Sands B E, Anderson F H, Bernstein C N et al.. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med. 2004; 350 876-885
34 Ochsenkuhn T, Goke B, Sackmann M. Combining infliximab with 6-mercaptopurine/azathioprine for fistula therapy in Crohn's disease. Am J Gastroenterol. 2002; 97 2022-2025
35 Rasul I, Wilson S R, MacRae H, Irwin S, Greenberg G R. Clinical and radiological responses after infliximab treatment for perianal fistulizing Crohn's disease. Am J Gastroenterol. 2004; 99(1) 82-88
36 Van Assche G, Vanbeckevoort D, Bielen D et al.. Magnetic resonance imaging of the effect of infliximab on perianal fistulizing Crohn's disease. Am J Gastroenterol. 2003; 98(2) 332-339
37 Poggioli G, Laureti S, Pierangeli F et al.. Local injection of infliximab for the treatment of perianal Crohn's disease. Dis Colon Rectum. 2005; 48(4) 768-774
38 Alexander-Williams J. Perianal Crohn's disease. In: Weterman IT, Pena AS, Booth CC The management of Crohn's disease, Proceedings of the Workshop on Crohn's disease. Amsterdam, the Netherlands; Excerpta Medica 1976: 239-244
39 Williams J G, Rothenberger D A, Nemer F D, Goldberg S M. Fistula- in-ano in Crohn's disease. Results of aggressive surgical treatment. Dis Colon Rectum. 1991; 34 378-384
40 Sangwan Y P, Schoetz Jr D J, Murray J J, Roberts P L, Coller J A. Perianal Crohn's disease. Results of local surgical treatment. Dis Colon Rectum. 1996; 39 529-535
41 Levien D H, Surrell J, Mazier W P. Surgical treatment of anorectal fistula in patients with Crohn's disease. Surg Gynecol Obstet. 1989; 169 133-136
42 Morrison J G, Gathright Jr J B, Ray J E, Ferrari B T, Hicks T C, Timmcke A E. Surgical management of anorectal fistulae in Crohn's disease. Dis Colon Rectum. 1989; 32 492-496
43 White R A, Eisenstat T E, Rubin R J, Salvati E P. Seton management of complex anorectal fistulae in patients with Crohn's disease. Dis Colon Rectum. 1990; 33 587-589
44 Topstad D R, Panaccione R, Heine J A, Johnson DRE, MacLean A R, Buie W D. Combined seton placement, infliximab infusion, and maintenance immunosuppressives improve healing rate in fistulizing anorectal Crohn's disease: a single center experience. Dis Colon Rectum. 2003; 46 577-583
45 Mizrahi N, Wexner S D, Zmora O et al.. Endorectal advancement flap: are there predictors of failure?. Dis Colon Rectum. 2002; 45 1616-1621
46 Joo J S, Weiss E G, Nogueras J J, Wexner S D. Endorectal advancement flap in perianal Crohn's disease. Am Surg. 1998; 64 147-150
47 Jones I T, Fazio V W, Jagelman D G. The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum. Dis Colon Rectum. 1987; 30 919-923
48 Lewis P, Bartolo D C. Treatment of trans-sphincteric fistulae by full thickness anorectal advancement flaps. Br J Surg. 1990; 77 1187-1189
49 Makowiec F, Jehle E C, Becker H D, Starlinger M. Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn's disease. Br J Surg. 1995; 82 603-606
50 Marchesa P, Hull T L, Fazio V W. Advancement sleeve flaps for treatment of severe perianal Crohn's disease. Br J Surg. 1998; 85 1695-1698
51 Zmora O, Mizrahi N, Rotholtz N et al.. Fibrin glue sealing in the treatment of perianal fistulas. Dis Colon Rectum. 2003; 46 584-589
52 O'Connor L, Champagne B, Ferguson M, Orangio G, Schertzer M, Armstrong D. Efficacy of anal fistula plug in closure of Crohn's anorectal fistulae. Dis Colon Rectum. 2006; 49 1569-1573
53 Yamamoto T, Allan R N, Keighley M R. Effect of fecal diversion alone on perianal Crohn's disease. World J Surg. 2000; 24 1258-1262
54 Edwards C M, George B D, Jewell D P, Warren B F, Mortensen N J, Kettlewell M G. Role of a defunctioning stoma in the management of large bowel Crohn's disease. Br J Surg. 2000; 87 1063-1066
55 Galandiuk S, Kimberling J, Al-Mishlab T, Stromberg A. Perianal Crohn's disease: predictors of the need for permanent diversion. Ann Surg. 2005; 241(5) 796-801
56 Rius J, Nessim A, Nogueras J J, Wexner S D. Gracilis transposition in complicated perianal fistula and unhealed perineal wounds in Crohn's disease. Eur J Surg. 2000; 166 218-222
57 Hull T L, Fazio V W. Surgical approaches to low anovaginal fistula in Crohn's disease. Am J Surg. 1997; 173 95-98
58 Sher M E, Bauer J J, Gelernt I. Surgical repair of rectovaginal fistulae in patients with Crohn's disease: transvaginal approach. Dis Colon Rectum. 1991; 34 641-648
59 Ky A, Sohn N, Weinstein M A, Korelitz B I. Carcinoma arising in anorectal fistulae of Crohn's disease. Dis Colon Rectum. 1998; 41 992-996

Dana SandsM.D.

Department of Colorectal Surgery, Cleveland Clinic Florida

2950 Cleveland Clinic Blvd., Weston, FL 33331

eMail: sandsd@ccf.org