title: Anal fissure in Crohn's disease: a plea for aggressive management.
abstract: OBJECTIVE
  This study was undertaken to identify clinical characteristics, natural history, and results of medical and surgical treatment of anal fissures in Crohn's disease.
  
  
  METHODS
  This is a retrospective review of patients with Crohn's disease and anal fissure.
  
  
  RESULTS
  Of the 56 study patients, 49 (84 percent) had symptomatic fissures. Fissures were most commonly (66 percent) located in the posterior midline, and 18 patients (32 percent) had multiple fissures. Fissures healed in one-half of patients treated medically. Factors predictive of successful medical treatment included male gender, painless fissure, and acute fissure. Of 15 patients, 10 (67 percent) treated surgically healed. Fissures in seven of eight patients (88 percent) who underwent anorectal procedures healed compared with fissures in only three of seven patients (43 percent) who underwent proximal intestinal resection. In the group of 50 patients with complete follow-up studies, an anal abscess or fistula from the base of an unhealed fissure developed in 13 patients (26 percent). More fissures healed after anorectal surgery (88 percent) than after medical treatment alone (49 percent; P = 0.05) or after abnormal surgery (29 percent; P = 0.03).
  
  
  CONCLUSIONS
  This series documents that unhealed fissures frequently progress to more ominous anal pathologic disease. Judicious use of internal sphincterotomy appears to be safe for fissures unresponsive to medical treatment.
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hitchcock Clinic, Burlington, Massachusetts 01805, USA.
authors.forename: P R
authors.initials: PR
authors.lastname: Fleshner
authors.forename: D J
authors.initials: DJ
authors.lastname: Schoetz
authors.forename: P L
authors.initials: PL
authors.lastname: Roberts
authors.forename: J J
authors.initials: JJ
authors.lastname: Murray
authors.forename: J A
authors.initials: JA
authors.lastname: Coller
authors.forename: M C
authors.initials: MC
authors.lastname: Veidenheimer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000150:complications* / Q000628:therapy; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome