Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;32(3):240-247.
doi: 10.5152/tjg.2021.191034.

Outcomes of Pediatric Fistulising Perianal Crohn's Disease

Bilge S Akkelle  1 , Ozlem K Sengul  1 , Burcu Volkan  1 , Engin Tutar  1 , Rabia Ergelen  2 , Samet Yardimci  3 , Deniz Ertem  1
Affiliations

Outcomes of Pediatric Fistulising Perianal Crohn's Disease

Bilge S Akkelle et al. Turk J Gastroenterol. 2021 Mar.

Abstract

Background: Perianal disease is reported more widely in pediatric Crohn patients than in the past, and has been stated as an independent modifier of the disease behavior. In this study, we aimed to analyze the clinical characteristics and outcomes of fistulising perianal Crohn's disease (fpCD) in the pediatric age group.

Methods: A total number of 149 children with an established diagnosis of inflammatory bowel disease who have been diagnosed before 18 years of age and followed in our tertiary center were revised. Clinical, endoscopic, laboratory, and radiologic data of 50 patients with CD, who had at least 18 months follow-up data, were compiled.

Results: Of 50 patients, 26 (52%) were diagnosed as fpCD (38% at onset). More than half of the patients without any notable external orifices around the perianal area were diagnosed as fpCD by an magnetic resonance imaging (MRI). Pediatric fpCD patients had a higher disease activity score and platelet count, lower serum albumin level, and a higher rate of granuloma in the biopsy samples, compared with non-fistulising patients. A considerably high rate of surgical interventions (i.e., seton placement 46% and abscess drainage 15%) was performed in combination with infliximab.

Conclusion: Fistulising perianal Crohn's disease seems to be more common than previously reported in the pediatric age group. A severe course of the disease might serve as a warning for the development of fpCD. A careful physical examination and use of perianal MRI with a high index of suspicion may increase the likelihood of fistula detection, hence may change the treatment strategy.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Axial contrast-enhanced T1W MRI images. (A) Abscess (long arrow) and intersphincteric fistula tract (short arrow). (B) Seton placed through the fistula (arrow), and a drained abscess is not visible.
Figure 2.
Figure 2.
Treatment strategy and outcome at 18 months follow-up in patients with fpCD at the onset.
Figure 3.
Figure 3.
Treatment strategy and outcome at 18 months follow-up in patients who developed fpCD at the follow-up.
See this image and copyright information in PMC

References

    1. Ruemmele FM, Veres G, Kolho KL.et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Crohns Colitis. 2014;8(10):1179–1207.. 10.1016/j.crohns.2014.04.005) - DOI - PubMed
    1. Van Limbergen J, Russell RK, Drummond HE.et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008;135(4):1114–1122.. 10.1053/j.gastro.2008.06.081) - DOI - PubMed
    1. Pigneur B, Seksik P, Viola S.et al. Natural history of Crohn’s disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis. 2010;16(6):953–961.. 10.1002/ibd.21152) - DOI - PubMed
    1. Levine A, Griffiths A, Markowitz J.et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis. 2011;17(6):1314–1321.. 10.1002/ibd.21493) - DOI - PubMed
    1. Sica GS, Di Carlo S, Tema G.et al. Treatment of peri-anal fistula in Crohn’s disease. World J Gastroenterol. 2014;20(37):13205–13210.. 10.3748/wjg.v20.i37.13205) - DOI - PMC - PubMed

Supplementary concepts

LinkOut - more resources