Management of perianal Crohn's disease.

Abstract

AbstractMost patients with perianal Crohn's disease are asymptomatic and perianal disease may resolve given adequate medical treatment for the underlying intestinal lesion. This will consist principally of sulphasalazine and prednisolone, both of which are known to be effective in the treatment of Crohn's disease. Should the local perianal disease become more severe, a trial of oral metronidazole may be worthwhile. The development of an ischiorectal or perianal abscess is an indication for the simplest surgical drainage procedure, and rectal strictures resulting from the healing of perianal fissures may be gently dilated. Further progression of disease may be treated by diversion of the fecal stream, but this will stand a greater chance of success in patients without florid rectal Crohn's disease. Fecal diversion is also indicated as a preliminary to the repair of rectovaginal fistulas. Patients with florid perianal Crohn's disease and severe anorectal disease will probably come to proctocolectomy, but initial defunctioning of the colon will make the operative procedure easier, may facilitate perineal healing, and some patients may actually avoid proctectomy with its high risk of a persistent perineal sinus.