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World J Gastrointest Pathophysiol. Aug 15, 2014; 5(3): 239-251
Published online Aug 15, 2014. doi: 10.4291/wjgp.v5.i3.239
Multidisciplinary and evidence-based management of fistulizing perianal Crohn’s disease
Ricardo Sordo-Mejia, Wolfgang B Gaertner
Ricardo Sordo-Mejia, Wolfgang B Gaertner, Division of Colon and Rectal Surgery, Department of Surgery, ABC Medical Center, 01120 Mexico City, Mexico
Author contributions: Sordo-Mejia R and Gaertner WB contributed to literature search and manuscript preparation.
Correspondence to: Wolfgang B Gaertner, MSc, MD, Division of Colon and Rectal Surgery, Department of Surgery, ABC Medical Center, Sur 136. No. 116-1A, Colonia Las Americas, 01120 Mexico City, Mexico. wolfganggaertnermd@gmail.com
Telephone: +52-55-10406569
Received: November 28, 2013
Revised: May 7, 2014
Accepted: May 28, 2014
Published online: August 15, 2014
Processing time: 280 Days and 5.4 Hours
Abstract

Perianal symptoms are common in patients with Crohn’s disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn’s disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn’s disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn’s disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn’s disease is crucial to improve outcomes.

Keywords: Perianal Crohn’s disease; Fistula; Abscess; Management; Review

Core tip: This manuscript is a comprehensive review that focuses on the multidisciplinary management of fistulizing perianal Crohn’s disease. The treatment options discussed in this review are based on a current literature review as well as our experience with the disease. Diagnostic and treatment algorithms are also provided.