Abstract
Crohn disease involves the perineum and rectum in approximately one-third of patients.
Symptoms can range from mild, including skin tags and hemorrhoids, to unremitting
and severe, requiring a proctectomy in a small, but significant, portion. Fistula-in-ano
and perineal sepsis are the most frequent manifestation seen on presentation. Careful
diagnosis, including magnetic resonance imaging or endorectal ultrasound with examination
under anesthesia and aggressive medical management, usually with a tumor necrosis
factor-alpha, is critical to success. Several options for definitive surgical repair
are discussed, including fistulotomy, fibrin glue, anal fistula plug, endorectal advancement
flap, and ligation of intersphincteric fistula tract procedure. All suffer from decreased
efficacy in patients with Crohn disease. In the presence of active proctitis or perineal
disease, no surgical therapy other than drainage of abscesses and loose seton placement
is recommended, as iatrogenic injury and poor wound healing are common in that scenario.
Keywords
anorectal - Crohn disease - fistula - abscess - flap - plug - ligation of intersphincteric
fistula tract (LIFT) - immunomodulators - fistulotomy
