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Clin Colon Rectal Surg 2022; 35(01): 051-057
DOI: 10.1055/s-0041-1740038
Review Article

A Multi-Disciplinary Approach to Perianal Fistulizing Crohn's Disease

Jacob Wiseman   *
1   Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Tanya Chawla   *
2   Mount Sinai Hospital, Department of Medical Imaging, Toronto, Ontario, Canada
,
Frederic Morin
3   Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada
,
Anthony de Buck van Overstraeten
3   Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada
,
Adam V. Weizman
1   Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract

Perianal fistulizing Crohn's disease represents a severe phenotype associated with significant morbidity. Patients with perianal fistulizing disease are more likely to have a severe disease course and have significant reductions in quality of life. Moreover, these patients are at risk for the development of distal rectal and anal cancers. Given the complexity and severity of this patient group, the management of perianal Crohn's disease must be undertaken by a multidisciplinary team. The gastroenterologist and colorectal surgeon play a critical role in the diagnosis and management of perianal fistulizing disease. An examination under anesthesia provides critical information and is an essential part of the work-up of complex perianal fistulas. The radiologist also plays a central role in characterizing anatomy and assessing response to treatment. Several imaging modalities are available for these patients with magnetic resonance imaging as the imaging modality of choice. Perianal disease developing after ileal pouch-anal anastomosis represents a particularly challenging form of fistulizing disease and requires a multidisciplinary clinical and radiologic approach to differentiate surgical complications from recurrent Crohn's disease.

Keywords

Crohn's disease - examination under anesthesia - inflammatory bowel disease - magnetic resonance imaging - perianal fistula

* Co-principal author.




Publication History

Article published online:
17 January 2022

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