Abstract
The management of fistulas largely depends on the extent of the fistula and the degree of inflammation and infection present. If a large infected fluid collection is present, this is usually drained in the operating room prior to any other intervention. Treatment with antibiotics is also common. At times, a drain called a seton is placed to keep the fluid collection from reforming. It is also important to assess both the internal and external opening of the fistula and the path of the tract between them in order to determine the best treatment option. This may be accomplished by an exam under anesthesia or other radiologic studies such as an MRI or an ultrasound study. The degree of inflammation from Crohn’s disease present in the rectum and anus must also be assessed. If inflammation is present, medical therapy is utilized first with the hopes of improving the degree of inflammation and promoting spontaneous closure of the fistula.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Williamson PR, Hellinger MD, Larach SW, Ferrara A. Twenty-year review of the surgical management of perianal Crohn’s disease. Dis Colon Rectum. 1995;38(4):389–92.
Spradlin NM, Wise PE, Herline AJ, Muldoon RL, Rosen M, Schwartz DA. A randomized prospective trial of endoscopic ultrasound to guide combination medical and surgical treatment for Crohn’s perianal fistulas. Am J Gastroenterol. 2008;103(10):2527–35.
Schwartz DA, Wiersema MJ, Dudiak KM, Fletcher JG, Clain JE, Tremaine WJ, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology. 2001;121(5):1064–72.
Schwartz DA, Loftus Jr EV, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology. 2002;122(4):875–80.
Ba’ath ME, Mahmalat MW, Kapur P, Smith NP, Dalzell AM, Casson DH, et al. Surgical management of inflammatory bowel disease. Arch Dis Child. 2007;92(4):312–6.
Fichera A, Michelassi F. Surgical treatment of Crohn’s disease. J Gastrointest Surg. 2007;11(6):791–803.
Gupta N, Cohen SA, Bostrom AG, Kirschner BS, Baldassano RN, Winter HS, et al. Risk factors for initial surgery in pediatric patients with Crohn’s disease. Gastroenterology. 2006;130(4):1069–77.
Loffler T, Welsch T, Muhl S, Hinz U, Schmidt J, Kienle P. Long-term success rate after surgical treatment of anorectal and rectovaginal fistulas in Crohn’s disease. Int J Colorectal Dis. 2009;24(5):521–6.
Mueller MH, Geis M, Glatzle J, Kasparek M, Meile T, Jehle EC, et al. Risk of fecal diversion in complicated perianal Crohn’s disease. J Gastrointest Surg. 2007;11(4):529–37.
Kamm MA, Ng SC. Perianal fistulizing Crohn’s disease: a call to action. Clin Gastroenterol Hepatol. 2008;6(1):7–10.
Hyman N. Endoanal advancement flap repair for complex anorectal fistulas. Am J Surg. 1999;178(4):337–40.
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(5):603–6.
van der Hagen SJ, Baeten CG, Soeters PB, van Gemert WG. Long-term outcome following mucosal advancement flap for high perianal fistulas and fistulotomy for low perianal fistulas: recurrent perianal fistulas: failure of treatment or recurrent patient disease? Int J Colorectal Dis. 2006;21(8):784–90.
Vitton V, Gasmi M, Barthet M, Desjeux A, Orsoni P, Grimaud JC. Long-term healing of Crohn’s anal fistulas with fibrin glue injection. Aliment Pharmacol Ther. 2005;21(12):1453–7.
Safar B, Jobanputra S, Sands D, Weiss EG, Nogueras JJ, Wexner SD. Anal fistula plug: initial experience and outcomes. Dis Colon Rectum. 2009;52(2):248–52.
O'Connor L, Champagne BJ, Ferguson MA, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of Crohn’s anorectal fistulas. Dis Colon Rectum. 2006;49(10):1569–73.
Yamamoto T, Allan RN, Keighley MR. Effect of fecal diversion alone on perianal Crohn’s disease. World J Surg. 2000;24(10):1258–62. Discussion 1262–3.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Ridolfi, T., Otterson, M.F. (2015). My Fistulas Are Just Not Healing. What Are You Going to Do About It? Surgical Management of Perianal Crohn’s Disease. In: Stein, D., Shaker, R. (eds) Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-14072-8_25
Download citation
DOI: https://doi.org/10.1007/978-3-319-14072-8_25
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-14071-1
Online ISBN: 978-3-319-14072-8
eBook Packages: MedicineMedicine (R0)