Diagnosis and surgical treatment of perianal Crohn’s disease

Abstract

Introduction. Perianal Crohn's disease (pCD) is a chronic inflammation of anal region, manifested by fissures, fistulas, abscesses or strictures. It is a marker of severe CD, associating with multiple relapses and operations. Can evolve in isolation (25%) or strike intestinal CD (75%). Correct early diagnosis, timed surgical implications constitute preconditions for success in the treatment of pCD. Purpose. Improvement of the diagnosis, of the early and late postoperative results in Perianal Crohn's disease (pCD). Material and methods. Retrospective study (2000-2019), based on the analysis of clinical observation files, results of paraclinical explorations and treatment of 52 patients with pCD. The investigation program was included: examination under anesthesia; endoscopy; imaging modalities (MRI, CT, fistulography, endorectal USG); histological explorations (biopsy, specimens). Conservative treatment was according to ECCO Protocol(2012). Results. Based on clinical, radiological, endoscopic and histological data, the definite diagnosis of pCD was possible in 72.7% of cases. Were operated 21 patients with pCD – drainage of perianal abscess (2), closure of the transphincterian fistula on Seton (6), fistulotomy (2), fistulectomy (3), closure of the recto-vaginal (2) or extrasphincterian (3) fistula with "advancement mucous flap", ileostomy (1), rectal resection with anastomosis (1), procectomy (1). Conclusions. The surgical attitude, individualized in each case, associated with biological therapy (infliximab), allows the essential reduction of relapses (23.8%), postoperative complications (14.3%) and lethality (4.8%).