ABSTRACT
The evaluation and management of anorectal fistulas in Crohn's disease remails a challenging
delemma. An adequate evaluation delineates the extent of disease and guides therapy
to alleviate symptoms while avoiding untoward side effects. Therapeutic options have
evolved over the last few decades and vary from medical therapy to operative techniques.
Medical therapy includes antibiotics and immunomodulators. Drainage setons or catheters
offer long-term palliation without the risk of incontinence. Cautiously aggressive
surgery, including fistulotomy and advancement flaps, allow significant symptomatic
improvement. A protective temporary loop ileostomy may be a useful adjunct in some
patients, especially in cases of redo flap surgery. If proctectomy is required, an
intersphincteric dissection optimizes the chance for wound healing. An algorithm is
presented to guide diagnosis and treatment.
KEYWORD
Crohn's disease - fistulas - anorectal - fistulo-in-ano
