title: Fistulizing Crohn's Disease Presenting After Surgery on a Perianal Lesion.
abstract: Perianal skin lesions, such as skin tags, can be an early presenting sign of Crohn's disease. Surgical intervention on these lesions may increase the risk of fistula development and lead to worse outcomes. This case series examined 8 patients who underwent surgical intervention on what appeared to be benign perianal skin lesions, only to reveal fistulas leading to the diagnosis of Crohn's disease. This patient population comprised 20% of all pediatric patients with Crohn's disease who had perianal fistula present at diagnosis. The initial type of perianal lesion varied from case to case and included skin tags, hemorrhoids, and perianal abscesses. All of the patients had other presenting features that, in retrospect, may have been attributed to Crohn's disease. None presented solely with a perianal lesion. Four patients had weight loss or growth failure. Most of the remainder had abnormal laboratory test results. These findings should raise the awareness of primary care providers that perianal lesions can be the first presenting sign of possible Crohn's disease in otherwise healthy appearing children. Such children should undergo a thorough evaluation for Crohn's disease before surgical intervention on perianal lesions because surgical procedures may be associated with worse outcomes.
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, jeradler@med.umich.edu.
authors.forename: Andrew A M
authors.initials: AA
authors.lastname: Singer
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, and Children's Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan.
authors.forename: Samir K
authors.initials: SK
authors.lastname: Gadepalli
authors.affiliation: Children's Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Eder
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Children's Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Adler
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000473:pathology; D001706:Biopsy; D002648:Child; D003424:Crohn Disease / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies