Management of perianal Crohn's disease. Results of a multicenter study in Italy.
OBJECTIVE
Management of perianal Crohn's disease is still controversial, and reports on large series are very few in the literature. The aim of this multicenter study was to investigate the outcome of both medical and surgical treatment in 225 patients.


METHODS
Patients cared for at different institutions were followed up for a median of six years. Most of them had either anal fistula or an abscess (86 percent and 43 percent, respectively), but fissures were also present in 26 percent of the cases. Diarrhea and anal pain were the most common symptoms. Anal lesions preceded the onset of intestinal symptoms in 19 percent of cases.


RESULTS
Medical treatment was curative only in 21 of 123 patients. Overall, medical and surgical treatment either cured or improved 62 percent of the cases. Fifty percent had an intestinal resection. Abscess drainage and fistulotomy were the most common anal surgeries. Rectovaginal fistulas (n = 30) required intestinal surgery in 36 percent and anal surgery in 20 percent of the cases, 50 percent with good results. Of 166 patients who had anal surgery, 97 (58 percent) had a positive outcome. Recurrence of anal disease requiring further surgery occurred in 24.5 percent of the cases.


CONCLUSIONS
Limited surgeries seem to achieve satisfactory results in more than one-half of the patients affected by perianal Crohn's lesions, whereas medical treatment alone is curative in a small portion of them.
Unità di Colonproctologia di Roma, Italy.
M
M
Pescatori
A
A
Interisano
L
L
Basso
F
F
Arcanà
P
P
Buffatti
F
F
Di Bella
A
A
Doldi
V
V
Forcheri
R
R
Gaetini
A
A
Pera
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001004:Anus Diseases / Q000145:classification / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D003125:Colostomy / Q000379:methods; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000379:methods; D008297:Male; D019804:Mesalamine; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D012086:Reoperation; D012460:Sulfasalazine / Q000627:therapeutic use; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000636:Aminosalicylic Acids; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D008795:Metronidazole; D012460:Sulfasalazine; D019804:Mesalamine