ISSN: 1859 - 2872
Update on diagnosis and treatment of perianal fistulising Crohn’s disease
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Abstract
Perianal fistula is a common and debilitating complication of Crohn’s disease. Pelvic magnetic resonance imaging (MRI) or endoanal ultrasound (EUS) should be obtained to delineate the anatomy of the fistula tract(s). Examination un-der anesthesia (EUA) also has an important role in the diagnosis of perianal fistula and allow immediate therapeutic intervention, including abscess drainage and/or seton placement. Highest diagnostic accuracy can be achieved if the combination of EUA with either MRI or EUS, EUA is used. Treatment approach depends on type of fistulas (simple or complex) and associated proctitis. Top-down strategy is usually indicated, especially in patients with complex fistulas or proctitis. Surgical drainage of sepsis and/or seton placement is the first line therapy before initiating immunosuppressive treatment. Anti-TNF can be used as first-line medical treatment, in combination with thiopurines and antibiotics. Definitive surgical repair of fistulas is only of consideration in the absence of luminal inflammation. Proctectomy with permanent stoma is preserved for severe, refractory complex fistulas.
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References
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