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Review
. 2018 Mar-Apr;31(2):129-139.
doi: 10.20524/aog.2018.0236. Epub 2018 Feb 8.

Medical and surgical management of perianal Crohn's disease

Samuel O Adegbola  1   2 , Anthea Pisani  3 , Kapil Sahnan  1   2 , Phil Tozer  1   2 , Pierre Ellul  3 , Janindra Warusavitarne  1   2
Affiliations
Review

Medical and surgical management of perianal Crohn's disease

Samuel O Adegbola et al. Ann Gastroenterol. 2018 Mar-Apr.

Abstract

Crohn's disease is increasingly thought to encompass multiple possible phenotypes. Perianal manifestations account for one such phenotype and represent an independent disease modifier. In its more severe form, perianal Crohn's disease confers a higher risk of a severe and disabling disease course, relapses, hospital admissions and operations. This, in turn, imposes a considerable burden and disability on patients. Identification of the precise manifestation is important, as management is nuanced, with both medical and surgical components, and is best undertaken in a multidisciplinary setting for both diagnosis and ongoing treatment. The introduction of biologic medication has heralded a significant addition to the management of fistulizing perianal Crohn's disease in particular, albeit with modest results. It remains a very challenging condition to treat and further work is required to optimize management in this group of patients.

Keywords: Crohn’s disease; medical therapy; perianal; surgery.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
(A and B) small and massive anal ulceration in patients with perianal Crohn’s disease
Figure 2
Figure 2
(A) Patient with skin tags and fistula with multiple external openings, (B) Fistula with multiple external openings, and scarring from previous surgery
Figure 3
Figure 3
Algorithm reproduced from ‘Management of Perianal Crohn’s Disease in the Biologic Era’, Coloproctology – A Practical Guide (Eds. Beynon, Harris, Davies, Evans) 2017 Chapter 1 (pgs 1-27), Adegbola SO, et al; Copyright Information – Springer International Publishing AG 2017, reproduced with permission of Springer EUA, examination under anesthesia
Figure 4
Figure 4
Algorithm reproduced for management of fistulating perianal Crohn’s disease in the Biologic Era’, Coloproctology – A Practical Guide (Eds. Beynon, Harris, Davies, Evans) 2017 Chapter 1 (pgs 1-27), Adegbola SO, et al; Copyright Information – Springer International Publishing AG 2017, reproduced with permission of Springer VAAFT, video assisted and fistula treatment; FiLaC, fistula tract laser closure; LIFT, ligation of intersphincteric fistula tract
See this image and copyright information in PMC

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