[Perineal lesions in childhood Crohn disease].
BACKGROUND
Perineal lesions (PAL) usually evolve together with bowel disease and often constitute a serious and disabling complication of Crohn's disease.


METHODS
Forty-three children (47%) with Crohn's disease developed PAL in a retrospective study of 92 patients ranging in age from 4 to 20 years.


RESULTS
PAL occurred at the mean age of 11.4 +/- 0.7 years, prior to diagnosis in 25% or subsequently in 21%. PAL were severe: complex fistulae (15%), rectovaginal fistulae (2%), anal raggedness (13%); moderate: subcutaneous fistulae (11%), abscesses (19%), cavitating ulcers (9.5%) and stricture formations (5.7%); or mild: eczema (6.7%), fissures (57%) and skin tags (17%). An association with these various features has been observed in 31%. The extent of involvement of the gastrointestinal tract was rectosigmoid (72%), ileal and colonic (41%), ileal with pancolitis (12%). Two PAL course profiles were observed: one with exacerbation and remissions (52%), the other without remission (48%), especially anal raggedness (100%), cavitating ulcers (80%) and skin tags (61%). Medical treatment included steroids (54%), metronidazole (53%), salicylates (51%), nutritional support (44%), azathioprine (17%). PAL healed in 41%. Surgical treatment was performed in 27% with 83% of healing. Relapses occurred in 35% after medical treatment and 86% after surgery.
Bellaiche
M
M
Service de gastroentérologie et nutrition pédiatriques, hôpital Robert-Debré, Paris, France.
Besnard
M
M
Faure
C
C
Cézard
J P
JP
Navarro
J
J
Mougenot
J F
JF
D000038:Abscess / Q000150:complications; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000150:complications* / Q000503:physiopathology; D004485:Eczema / Q000150:complications; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications*; D007412:Intestinal Fistula / Q000150:complications; D008297:Male; D010502:Perineum; D012189:Retrospective Studies; D012871:Skin Diseases / Q000150:complications; D014456:Ulcer / Q000150:complications; D014624:Vaginal Fistula / Q000150:complications