Protocolo diagnóstico y terapéutico de la enfermedad fistulizante perianal

Abstract

More than 30% of patients with Crohn's disease will present perianal manifestations of the disease. These include fissures, ulcers, and fistulas that produce symptoms such as perianal discharge, anal pain, and tenesmus. It is important to perform an adequate clinical interview as well as to ask about sexual practices and perform a perianal exploration. If perianal disease (PAD) is suspected, it is advisable to characterize the lesions using magnetic resonance imaging or an endoanal ultrasound. In the case of complex, active perianal disease, an examination under anesthesia with seton placement should be considered. In the case of perianal abscess, urgent surgical drainage is indicated. The management of PAD must also include medical treatment with TNFa-blocking drugs such as infliximab in combination or not with thiopurines. In refractory cases, a terminal colostomy or coloproctectomy may be required.