Management of complex perianal Crohn's disease

Lara Aguilera-Castro, Carlos Ferre-Aracil, Ana Garcia-Garcia-de-Paredes, Enrique Rodriguez-de-Santiago, Antonio Lopez-Sanroman, Lara Aguilera-Castro, Carlos Ferre-Aracil, Ana Garcia-Garcia-de-Paredes, Enrique Rodriguez-de-Santiago, Antonio Lopez-Sanroman

Abstract

Patients with Crohn's disease often develop perianal disease, successfully managed in most cases. However, its most aggressive form, complex perianal disease, is associated with high morbidity and a significant impairment in patients' quality of life. The aim of this review is to provide an updated approach to this condition, reviewing aspects of its epidemiology, diagnosis and therapeutic alternatives. Emerging treatment options are also discussed. A multidisciplinary assessment of these patients with a coordinated medical and surgical approach is crucial.

Keywords: Crohn’s disease; perianal abscess; perianal disease; perianal fistula.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Transsphincteric fistula. Axial T1-weighted image (A) demonstrated high signal intensity tract (13 cm in length) under puborectalis muscle. Axial T-weighted image (B) in the same patient illustrates the progression fistula to the gluteal cleft
Figure 2
Figure 2
Diagnostic algorithm for complex perianal Crohn’s disease. If abscess is suspected, MRI may be used as a diagnostic method, if readily available, before drainage[18] MRI, magnetic resonance imaging; EUS, endoanal ultrasound; EUA, examination under anesthesia

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