Skip to main content

The Management of Perianal Crohn’s Disease

  • Chapter
Progress in Colorectal Surgery

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Allan A, Keighley MRB. Management of perianal Crohn’s disease. World J Surg. 1988;12: 198–202.

    PubMed  CAS  Google Scholar 

  2. Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis: a pathologic and clinical entity. J Am Med Assoc. 1932;99:1323–1328.

    Google Scholar 

  3. Alexander-Williams J, Buchmann P. Perianal Crohn’s disease. World J Surg. 1980;4: 203–208.

    PubMed  CAS  Google Scholar 

  4. Frizelle FA, Santoro GA, Pemberton JH. The management of perianal Crohn’s disease. Int J Colorect Dis. 1996;11:227–237.

    Article  CAS  Google Scholar 

  5. Lapidus A, Bernell O, Hellers G, Lofberg R. Clinical course of colorectal Crohn’s disease: a 35-year follow-up study of 507 patients. Gastroenerology 1998;114:1151–1160.

    CAS  Google Scholar 

  6. McClane SJ, Rombeau JL. Anorectal Crohn’s disease. Surg Clin North Am. 2001;81: 169–183.

    Article  PubMed  CAS  Google Scholar 

  7. Pescatori M, Interisano MD, Basso L, et al. Management of perianal Crohn’s Disease: results of a multicenter study in Italy. Dis Colon Rectum. 1995;8:121–124.

    Google Scholar 

  8. Fielding JH. Perianal lesions in Crohn’s disease. J R Coll Surg Edin. 1972:17:32–37.

    CAS  Google Scholar 

  9. Buchmann P, Keighley MRB, Allan RN, Thompson H, Alexander-Williams J. Natural history of perianal Crohn’s disease. Ten year follow up: a plea for conservatism. Am J Surg. 1980;140:642–644.

    PubMed  CAS  Google Scholar 

  10. Alexander-Williams J. Fistula-in-ano: management of Crohn’s fistula. Dis Colon Rectum. 1976; 19:518–529.

    PubMed  CAS  Google Scholar 

  11. Buchmann P, Alexander-Williams J. Classification of perianal Crohn’s disease. Clin Gastroenterol. 1980;9:323–331.

    PubMed  CAS  Google Scholar 

  12. Hughes LE. Clinical classification of perianal Crohn’s disease. Dis Colon Rectum. 1992; 35:928–932.

    Article  PubMed  CAS  Google Scholar 

  13. Bayer I, Gordon PH. Selected management of fistula in ano in Crohn’s disease. Dis Colon Rectum. 1994;37:760–765.

    Article  PubMed  CAS  Google Scholar 

  14. Sloots CEJ, Felt-Bersma RJF, Poen AC, Cuesta MA, Meuwissen SGM. Assessment and classification of fistula-in-ano in patients with Crohn’s disease by hydrogen peroxide enhanced transanal ultrasound. Int J Colorectal Dis. 2001;16:292–297.

    PubMed  CAS  Google Scholar 

  15. Makowiec F, Jehle EC, Starlinger M. Clinical course of perianal fistulas in Crohn’s disease. Gut 1995;37:696–701.

    PubMed  CAS  Google Scholar 

  16. Schwartz DA, Wiersema MJ, Dudiak KM, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology 2001; 121: 1064–1072.

    Article  PubMed  CAS  Google Scholar 

  17. Orsoni P, Barthet M, Portier F, Panuel M, Desjeux A, Grimaud AC. Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscesses complicating Crohn’s disease. Br J Surg. 1998;86:360–364.

    Google Scholar 

  18. Makowiec F, Jehle EC, Becker H-D, Starlinger M. Perianal abscess in Crohn’s disease. Dis Colon Rectum. 1997;40:443–450.

    Article  PubMed  CAS  Google Scholar 

  19. Sohn N, Korelitz BI, Weinstein MA. Anorectal Crohn’s disease: definitive surgery for fistulas and recurrent abscesses. Am J Surg. 1980;139:394–397.

    Article  PubMed  CAS  Google Scholar 

  20. Pritchard TJ, Schoetz DJ, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC. Perirectal abscess in Crohn’s disease: drainage and outcome. Dis Colon Rectum. 1990;33:933–937.

    Article  PubMed  CAS  Google Scholar 

  21. Williamson PR, Hellinger MD, Larah SW, Ferrara A. Twenty year review of the surgical management of perianal Crohn’s disease. Dis Colon Rectum. 1995;38:389–392.

    PubMed  CAS  Google Scholar 

  22. Keighley MRB, Allan RN. Current status and influence of operation on perianal Crohn’s disease. Int J Colorectal Dis. 1986;1:104–107.

    Article  PubMed  CAS  Google Scholar 

  23. Fry RD, Shemesh EI, Kodner IJ, Timmcke A. Techniquest and results in the management of anal and perianal Crohn’s disease. Surg Gynaecol Obstet. 1989;168:42–48.

    CAS  Google Scholar 

  24. Sweeney JL, Ritchie JK, Nicholls RJ. Anal fissure in Crohn’s disease. Br J Surg. 1988; 75:56–57.

    PubMed  CAS  Google Scholar 

  25. Fleshner PR, Schoetz DJ Jr, Roberts PL, et al. Anal fissure in Crohn’s disease: a plea for aggressive management. Dis Colon Rectum. 1995;38:1137–1143.

    PubMed  CAS  Google Scholar 

  26. Hobbis JH, Schofield PF. Management of perianal Crohn’s disease. J Roy Soc Med. 1982; 75:414–417.

    Google Scholar 

  27. Sohn N, Korelitz BI. Local operative treatment of anorectal Crohn’s disease. J Clin Gastroenterol. 1982;4:395–399.

    PubMed  CAS  Google Scholar 

  28. Wolkomir AF, Luchtefeld MA. Surgery for symptomatic hemorrhoids and anal fissures in Crohn’s disease. Dis Colon Rectum. 1993;36:545–547.

    Article  PubMed  CAS  Google Scholar 

  29. Halme L, Sanio AP. Factors related to frequency, type, and outcome of anal fistulas in Crohn’s disease. Dis Colon Rectum. 1995;38:55–59.

    Article  PubMed  CAS  Google Scholar 

  30. Scott A, Hawley PR, Phillips RKS. Results of external sphincter repair in Crohn’s disease. Br J Surg. 1989;76:959–960.

    PubMed  CAS  Google Scholar 

  31. Marks CG, Ritchie JK, Lockhart-Mummery HE. Anal fistulas in Crohn’s disease. Br J Surg. 1981;68:525–527.

    PubMed  CAS  Google Scholar 

  32. Nordgren S, Fasth S, Hulten L. Anal fistulas in Crohn’s disease: incidence and outcome of surgical treatment. Int J Colorectal Dis. 1992;7:214–218.

    Article  PubMed  CAS  Google Scholar 

  33. Williams JG, Rothenberger DA, Nemer FD, et al. Fistula-in-ano in Crohn’s disease: results of aggressive surgical treatment. Dis Colon Rectum. 1991;34:378–384.

    Article  PubMed  CAS  Google Scholar 

  34. Morrison JG, Gathright JB Jr, Ray JE, Ferrari BT, Hicks TC, Timmcke AE. Surgical management of anorectal fistulas in Crohn’s disease. Dis Colon Rectum. 1989;32:492–496.

    PubMed  CAS  Google Scholar 

  35. Van Dongen LM, Lubbers E-J. Perianal fistulas in patients with Crohn’s disease. Arch Surg. 1986;121:1187–1190.

    PubMed  Google Scholar 

  36. Fuhrmann G, Larch SW. Experience with perirectal fistulas in patients with Crohn’s disease. Dis Colon Rectum. 1989;32:847–848.

    Google Scholar 

  37. Hellers G, Bergstrand O, Ewerth S, Holmstrom B. Occurrence and outcome after primary treatment of anal fistulae in Crohn’s disease. Gut 1980;21:525–527.

    PubMed  CAS  Google Scholar 

  38. Levien DH, Surrell J, Mazier WP. Surgical treatment of anorectal fistula in patients with Crohn’s disease. Surg Gynaecol Obstet. 1989;169:133–136.

    CAS  Google Scholar 

  39. Athanasiadis S, Girona J. New methods of treatment of perianal fistulas in Crohn’s disease. Long term results in 81 patients. Langenbecks Arch Chir. 1983;360:119–132.

    PubMed  CAS  Google Scholar 

  40. Williams JG, MacLeod CA, Rothenberger DA, et al. Seton treatment of high anal fistulae. Br J Surg. 1991;78:1159–1161.

    PubMed  CAS  Google Scholar 

  41. Van Tets WF, Kuijpers JH. Seton treatment of perianal fistula with high anal or rectal opening. Br J Surg. 1995;82:895–897.

    PubMed  Google Scholar 

  42. Garcia-Aguilar J, Belmonte C, Wong DW, Goldberg SM, Madoff RD. Cutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula. Br J Surg. 1988;85:243–245.

    Google Scholar 

  43. McCourtney JS, Finlay IG. Cutting seton without preliminary internal sphincterotomy in management of complex high fisula-in-ano. Dis Colon Rectum. 1996;39:55–58.

    Article  PubMed  CAS  Google Scholar 

  44. Bodzin JH. Laser ablation of complex perianal fisulas preserves continence and is a rectum-sparing alternative in Crohn’s disease patients. Am Surg. 1998;64:627–632.

    PubMed  CAS  Google Scholar 

  45. Janowitz HD, Creon EC, Sachar DB. The role of the fecal stream in Crohn’s disease: an historical and analytical review. Inflamm Bowel Dis. 1998;4:29–39.

    PubMed  CAS  Google Scholar 

  46. Harper PH, Kettlewell MG, Lee EC. The effect of split ileostomy on perianal Crohn’s disease. Br J Surg. 1982;69:608–610.

    PubMed  CAS  Google Scholar 

  47. Zelas P, Jagelman DG. Loop ileostomy in the management of Crohn’s colitis in the debilitated patient. Ann Surg. 1980;191:164–168.

    PubMed  CAS  Google Scholar 

  48. Burman JH, Thompson H, Cooke WT, Williams J. The effect of diversion of intestinal contents on the progress of Crohn’s disease of the large bowel. Gut 1971;12:11–15.

    PubMed  CAS  Google Scholar 

  49. Edwards CM, George BD, Jewell DP, et al. Role of a defunctioning stoma in the management of large bowel Crohn’s disease. Br J Surg. 2000;87:1063–1066.

    Article  PubMed  CAS  Google Scholar 

  50. Williamson MER, Hughes LE. Bowel diversion should be used with caution in stenosing anal Crohn’s disease. Gut 1994;35:1139–1140.

    PubMed  CAS  Google Scholar 

  51. Yamamoto T, Allan RN, Keighley MR. Effect of faecal diversion alone on perianal CD. World J Surg. 2000;24:1258–1263.

    PubMed  CAS  Google Scholar 

  52. Jones IT, Fazio VW, Jagelman DG. The use of trans anal rectal advancement flap in the management of fisulas involving the anorectum. Dis Colon Rectum. 1987;30:919–923.

    PubMed  CAS  Google Scholar 

  53. Kodner IJ, Mazor A, Shemesh EI, et al. Endorectal advancement flap repair of rectovaginal an dother complicated anorectal fistulas. Surgery 1993;114:682–690.

    PubMed  CAS  Google Scholar 

  54. Bergstrand O, Ewerth S, Hellers G, Holmstrom B, Ullman J, Wallberg P. Outcome following treatment of anal fistulae in Crohn’s disease. Acta Chir Scand. 1980;(suppl 500):43–44.

    Google Scholar 

  55. Heuman R, Bolin T, Sjodahl R, Tagesson C. The incidence and course of perianal complications and arthralgia after intestinal resection with restoration of continuity for Crohn’s disease. Br J Surg. 1981; 68: 528–530.

    PubMed  CAS  Google Scholar 

  56. Robertson WG, Mangione JS. Cutaneous advancement flap closure: alternative method for treatment of complicated anal fistulas. Dis Colon Rectum. 1998;41:884–887.

    Article  PubMed  CAS  Google Scholar 

  57. Makowiec F, Jehle EC, Becker HD, Starlinger M. Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn’s disease. Br J Surg. 1995;82:603–606.

    PubMed  CAS  Google Scholar 

  58. Rothenberger DA, Christenson CE, Balcos EG. Endorectal advancement flap for the treatment of simple rectovaginal fistula. Dis Colon Rectum. 1982;25:297–300.

    PubMed  CAS  Google Scholar 

  59. Marchesa P, Hull TL, Fazio VW. Advancement sleeve flaps for treatment of severe perianal Crohn’s disease. Br J Surg. 1998;85:1695–1698.

    Article  PubMed  CAS  Google Scholar 

  60. Scott HJ, Northover JMA. Evaluation of surgery for perianal Crohn’s fistulas. Dis Colon Rectum. 1996;39:1039–1043.

    Article  PubMed  CAS  Google Scholar 

  61. Christensen MA, Ptisch RM, Cali RL, Blatchford GJ, Thorson AG. “House” advancement pedicle flap for anal stenosis. Dis Colon Rectum. 1992;35:201–203.

    Article  PubMed  CAS  Google Scholar 

  62. Lewis P, Bartolo DCC. Treatment of trans-sphincteric fistulae by full thickness anorectal advancement flaps. Br J Surg. 1990;77:1187–1189.

    PubMed  CAS  Google Scholar 

  63. Radcliffe AG, Ritchie JK, Hawley PR, Lennard-Jones JE, Northover JMA. Anovaginal and rectovaginal fistulas in Crohn’s disease. Dis Colon Rectum. 1988;31:94–99.

    PubMed  CAS  Google Scholar 

  64. Bauer JJ, Sher ME, Jaffin H, Present D, Gelerent I. Transvaginal approach for repair of rectovaginal fistulae complicating Crohn’s disease. Ann Surg. 1991;213:151–158.

    PubMed  CAS  Google Scholar 

  65. O’Leary DP, Milroy CE, Durdey P. Definitive repair of anovaginal fistula in Crohn’s disease. Ann R Coll Surg Engl. 1998;80:250–252.

    PubMed  CAS  Google Scholar 

  66. Hyman N. Endoanal advancement flap repair for complex anorectal fistulas. Am J Surg. 1999;178: 337–340.

    Article  PubMed  CAS  Google Scholar 

  67. Hull TL, Fazio VW. Surgical approaches to low anovaginal fistula in Crohn’s disease. Am J Surg. 1997;173:95–98.

    Article  PubMed  CAS  Google Scholar 

  68. Sher ME, Bauer JJ, Gelernt I. Surgical repair of rectovaginal fistulas in patients with Crohn’s disease: transvaginal approach. Dis Colon Rectum. 1991;34:641–648.

    Article  PubMed  CAS  Google Scholar 

  69. Linares L, Moreira LF, Andrews H, Allan RN, Alexander-Williams J, Keighley MRB. Natural history and treatment of anorectal strictures complicating Crohn’s disease. Br J Surg. 1988;75:653–655.

    PubMed  CAS  Google Scholar 

  70. Baudot P, Keighley MR, Alexander-Williams J. Perineal wound healing after proctectomy for carcinoma and inflammatory disease. Br J Surg. 1980;67:275–276.

    PubMed  CAS  Google Scholar 

  71. Ferrari BT, DenBesten L. The prevention and treatment of the persistent perineal sinus. World J Surg. 1980;4:167–172.

    PubMed  CAS  Google Scholar 

  72. Yamamoto T, Bain IM, Allan RN, Keighley MRB. Persistent perineal sinus after proctocolectomy for Crohn’s disease. Dis Colon Rectum. 1999;42:96–101.

    PubMed  CAS  Google Scholar 

  73. Moody G, Probert CSJ, Srivastava EM, Rhodes J, Mayberry JF. Sexual dysfunction amongst women with Crohn’s disease: a hidden problem. Digestion 1992;52:179–183.

    Article  PubMed  CAS  Google Scholar 

  74. Rogers RG, Katz VL. Course of Crohn’s disease during pregnancy and its effect on pregnancy outcome: a retrospective review. Am J Perinatol. 1995;12:262–264.

    Article  PubMed  CAS  Google Scholar 

  75. Ilnyckyj A, Blanchard JF, Rawsthorne P, Bernstein CN. Perianal Crohn’s disease and pregnancy: role of the mode of discovery. Am J Gastroenterol. 1999;94:3274–3278.

    Article  Google Scholar 

  76. Bernstein D, Rogers A. Malignancy in Crohn’s disease. Am J Gastroenterol. 1996;91: 434–440.

    PubMed  CAS  Google Scholar 

  77. Somerville KW, Langman MJS, Da Cruz DJ, Balfour TW, Sully L. Malignant transformation of anal skin tags in Crohn’s disease. Gut 1884;25:1124–1125.

    Google Scholar 

  78. Yamazaki Y, Ribiero MB, Sachar DB et al. Malignant colorectal strictures in Crohn’s disease. Am J Gastroenterol. 1991;86:882–885.

    PubMed  CAS  Google Scholar 

  79. Ky A, Sohn N, Weinstein MA, Korelitz BI. Carcinoma arising in anorectal fistulas of Crohn’s disease. Dis Colon Rectum. 1998;41:992–996.

    Article  PubMed  CAS  Google Scholar 

  80. Stein RB, Lichtenstein GR. Medical therapy for Crohn’s disease: the state of the art. Surg Clin North Am. 2001;81:71–101.

    Article  PubMed  CAS  Google Scholar 

  81. Jakobovits J, Schuster MM. Metronidazole therapy for Crohn’s disease and associated fistulae. Am J Gastroenterol. 1984;79:533–541.

    PubMed  CAS  Google Scholar 

  82. Turunen U, Farkkila M, Seppala K. Long-term treatment of perianal or fistulous Crohn’s disease with Ciprofloxacin. Scand J Gastroenterol. 1989;24:144.

    Google Scholar 

  83. Solomon M, McCleod R, O’Connor B, et al. Combination of ciprofloxacin and Metronidazole in severe perianal Crohn’s disease. Can J Gastroenterol. 1993;7:571–573.

    Google Scholar 

  84. Pearson DC, May GR, Fick GH, Sutherland LR. Azathioprine and 6-Mercaptopurine in Crohn disease. Ann Intern Med. 1995;122:132–142.

    Google Scholar 

  85. Present DH, Lichtiger S. Efficacy of Cuclosporine in treatment of fistula of Crohn’s disease. Dig Dis Sci. 1994;39:374–380.

    Article  PubMed  CAS  Google Scholar 

  86. Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med. 1999;340:1398–1405.

    Article  PubMed  CAS  Google Scholar 

  87. Van Bodegraven AA, Sloots EJ, Felt-Bersma RJF, Meuwissen SGM. Endosonographic evidence of persistence of Crohn’s disease—associated fistulas after infliximab tretement, irrespective of clinical response. Dis Colon Rectum. 2002;45:39–46.

    PubMed  Google Scholar 

  88. Ricart E, Panaccione R, Loftus EV, Tremaine WJ, Sandborn WJ. Successful management of Crohn’s disease of the ileoanal pouch with infliximab. Gastroenterology 1999;117:429–432.

    PubMed  CAS  Google Scholar 

  89. Farrell RJ, Shah SA, Lodhavia PJ, et al. Clinical experience with infliximab therapy in 100 patients with Crohn’s disease. Am J Gastroenterol. 2000;95:3490–3497.

    Article  PubMed  CAS  Google Scholar 

  90. Ricart E, Sandborn WJ. Infliximab for the treatment of fistulas in patients with Crohn’s disease— comment. Gastroenterology 1999;117:1247–1251.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Springer-Verlag London Limited

About this chapter

Cite this chapter

Allan, A., Bearn, P.E. (2005). The Management of Perianal Crohn’s Disease. In: Beynon, J., Carr, N.D. (eds) Progress in Colorectal Surgery. Springer, London. https://doi.org/10.1007/1-84628-058-3_5

Download citation

  • DOI: https://doi.org/10.1007/1-84628-058-3_5

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-85233-823-7

  • Online ISBN: 978-1-84628-058-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics