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Imaging techniques and combined medical and surgical treatment of perianal Crohn’s disease

  • Review Article
  • Published:
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Abstract

Crohn’s disease is a chronic inflammatory disease which may involve any segment of the gastrointestinal tract, most frequently the terminal ileum, the large intestine, and the perianal region. The symptoms of perianal Crohn’s disease include skin disorders, hemorrhoids, anal ulcers, anorectal stenosis, perianal abscesses and fistulas, rectovaginal fistulas and carcinoma of the perianal region. The perianal manifestations of Crohn’s disease cause great discomfort to the patient and are among the most difficult aspects to treat. Management of perianal disease requires a combination of different imaging modalities and a close cooperation between gastroenterologists and dedicated surgeons.

Riassunto

La malattia di Crohn è una malattia infiammatoria cronica che può coinvolgere qualsiasi segmento del tratto gastroenterico, più frequentemente l’ileo terminale, il grosso intestino e la regione perianale. Le manifestazioni della malattia di Crohn perianale comprendono: alterazioni cutanee, emorroidi, ulcere anali, stenosi ano-rettali, ascessi e fistole perianali, fistole retto-vaginali e cancro della regione perianale. Le manifestazioni perianali della malattia sono una delle principali fonti di disagio per il paziente ed uno degli aspetti della malattia di Crohn più difficili da trattare. La gestione della malattia perianale richiede un’integrazione fra differenti metodiche di imaging e una stretta collaborazione fra gastroenterologi e chirurghi dedicati.

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References

  1. Sandborn WJ, Fazio VW, Feagan BG et al (2003) AGA technical review on perianal Crohn’s disease. Gastroenterology 125:1508–1530

    PubMed  Google Scholar 

  2. Schwartz DA, Pemberton JH, Sandborn WJ (2001) Diagnosis and treatment of perianal fistulas in Crohn’s disease. Ann Intern Med 135:906–918

    CAS  PubMed  Google Scholar 

  3. Allan A, Keighley RB (1988) Management of perianal disease. World J Surg 12:198–202

    CAS  PubMed  Google Scholar 

  4. Hellers G, Bergstrand O, Ewerth S et al (1980) Occurrence and outcome after primary treatment of anal fistulae in Crohn’s disease. Gut 21:525–527

    PubMed Central  CAS  PubMed  Google Scholar 

  5. Schwartz DA, Loftus E, Tremaine W et al (2002) The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology 122:875–880

    PubMed  Google Scholar 

  6. Makowiec F, Jehle EC, Starlinger M (1995) Clinical course of perianal fistulas in Crohn’s disease. Gut 37:696–701

    PubMed Central  CAS  PubMed  Google Scholar 

  7. Sands BE, Anderson FH, Bernstein CN et al (2004) (2004) Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 350:876–885

    CAS  PubMed  Google Scholar 

  8. Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63:1–12

    CAS  PubMed  Google Scholar 

  9. Wise PE, Schwartz DA (2012) The evaluation and treatment of Crohn perianal fistulae: EUA, EUS, MRI, and other imaging modalities. Gastroenterol Clin N Am 41:379–391

    Google Scholar 

  10. Siddiqui MRS, Ashrafian H, Tozer P et al (2012) A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum 55:576–585

    PubMed  Google Scholar 

  11. Schwartz DA, Wiersema MJ, Dudiak KM et al (2001) A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology 121:1064–721995

    CAS  PubMed  Google Scholar 

  12. Schwartz DA, Herdman CR (2004) Review article: the medical treatment of Crohn’s perianal fistulas. Aliment Pharmacol Ther 19:953–967

    CAS  PubMed  Google Scholar 

  13. Irvine EJ (1995) Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index. J Clin Gastroenterol 20:27–32

    CAS  PubMed  Google Scholar 

  14. Present DH, Rutgeerts P, Targan S et al (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340:1398–1405

    CAS  PubMed  Google Scholar 

  15. Ardizzone S, Maconi G, Colombo E et al (2004) Perianal fistulae following Infliximab treatment: clinical and endosonographic outcome. Inflamm Bowel Dis 10:91–96

    PubMed  Google Scholar 

  16. Van Bodegraven AA, Sloots CEJ, Felt-Bersma RJF, Meuwissen SGM (2002) Endosonographic evidence of persistence of Crohn’s disease associated fistulas after infliximab treatment, irrespective of clinical response. Dis Colon Rectum 45:39–46

    PubMed  Google Scholar 

  17. Van Assche G, Vanbeckevoort D, Bielen D et al (2003) Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn’s disease. Am J Gastroenterol 98:33–39

    Google Scholar 

  18. Bell SJ, Halligan S, Windsor ACJ, Williams AB, Wiesel P, Kamm MA (2003) Response of fistulating Crohn’s disease to infliximab treatment assessed by magnetic resonance imaging. Aliment Pharmacol Ther 17:387–393

    CAS  PubMed  Google Scholar 

  19. Haggett PJ, Moore NR, Shearman JD, Travis SPL, Jewell DP, Mortensen NJ (1995) Pelvic and perineal complications of Crohn’s disease: assessment using magnetic resonance imaging. Gut 36:407–410

    PubMed Central  CAS  PubMed  Google Scholar 

  20. Tissot O, Bodnar D, Henri L, Dubreuille A, Valette PJ (1996) MR T2 weighted aspect of perianal fistulas. J Radiol 77:253–260

    CAS  PubMed  Google Scholar 

  21. O’Malley RB, Al-Hawary MM, Kaza RK, Wasnik AP, Liu PS, Hussain HK (2012) Rectal imaging: part 2, Perianal fistula evaluation on pelvic MRI—what the radiologist needs to know. AJR Am J Roentgenol 199:W43–W53

    PubMed  Google Scholar 

  22. Ziech M, Felt-Bersma R, Stoker J (2009) Imaging of perianal fistulas. Clin Gastroenterol Hepatol 7:1037–1045

    PubMed  Google Scholar 

  23. Villa C, Pompili G, Franceschelli G et al (2012) Role of magnetic resonance imaging in evaluation of the activity of perianal Crohn’s disease. Eur J Radiol 81:616–622

    PubMed  Google Scholar 

  24. Ziech MLW, Lavini C, Bipat S et al (2013) Dynamic contrast-enhanced MRI in determining disease activity in perianal fistulizing Crohn disease: a pilot study. AJR Am J Roentgenol 200:W170–W177

    PubMed  Google Scholar 

  25. Law PJ, Talbot RW, Bartram CI, Northover JMA (1989) Anal endosonography in the evaluation of perianal sepsis and fistula in ano. Br J Surg 76:752–755

    CAS  PubMed  Google Scholar 

  26. Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR (2004) Clinical examination, endosonography, and MRI imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology 233:674–681

    PubMed  Google Scholar 

  27. Bartram CI, Buchanan G (2003) Imaging anal fistula. Radiol Clin N Am 41:443–457

    PubMed  Google Scholar 

  28. Caprioli F, Losco A, Viganò C et al (2006) Computer-assisted evaluation of perianal fistula activity by means of anal ultrasound in patients with Crohn’s disease. Am J Gastroenterol 101:1551–1558

    PubMed  Google Scholar 

  29. Losco A, Viganò C, Conte D, Cesana BM, Basilisco G (2009) Assessing the activity of perianal Crohn’s disease: comparison of clinical indices and computer-assisted anal ultrasound. Inflamm Bowel Dis 15:742–749

    PubMed  Google Scholar 

  30. Wiese DM, Schwartz DA (2012) Managing perianal Crohn’s disease. Curr Gastroenterol Rep 14:153–161

    PubMed  Google Scholar 

  31. Seow C, Phillips RK (1991) Insights gained from the management of problematic anal fistulae at St. Mark’s Hospital, 1984–88. Br J Surg 78:539–541

    Google Scholar 

  32. Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD (1996) Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum 39:723–729

    CAS  PubMed  Google Scholar 

  33. Spencer JA, Chapple K, Wilson D, Ward J, Windsor AC, Ambrose NS (1998) Outcome after surgery for perianal fistula: predictive value of MR imaging. AJR Am J Roentgenol 171:403–406

    CAS  PubMed  Google Scholar 

  34. Beets-Tan RG, Beets GL, van der Hoop AG et al (2001) Preoperative MR imaging of anal fistulas: does it really help the surgeon? Radiology 218:75–84

    CAS  PubMed  Google Scholar 

  35. Buchanan G, Halligan S, Williams A et al (2002) Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet 360:1661–1662

    PubMed  Google Scholar 

  36. Spradlin NM, Wise PE, Herline AJ, Muldoon RL, Rosen M, Schwartz DA (2008) A randomized prospective trial of endoscopic ultrasound to guide combination medical and surgical treatment for Crohn’s perianal fistulas. Am J Gastroenterol 103:2527–2535

    PubMed  Google Scholar 

  37. Bernstein LH, Frank MS, Brandt LJ, Boley SJ (1980) Healing of perineal Crohn’s disease with metronidazole. Gastroenterology 79:599

    CAS  PubMed  Google Scholar 

  38. Brandt LJ, Bernstein LH, Boley SJ, Frank MS (1982) Metronidazole therapy for perineal Crohn’s disease: a follow up study. Gastroenterology 83:383–387

    CAS  PubMed  Google Scholar 

  39. Jacobovits J, Schuster MM (1984) Metronidazole therapy for Crohn’s disease and associated fistulae. Am J Gastroenterol 79:533–540

    Google Scholar 

  40. Turunen U, Farkilla M, Valtonen V (1993) Long-term outcome of ciprofloxacin treatment in severe perianal or fistulous Crohn’s disease. Gastroenterology 104:A793

    Google Scholar 

  41. Solomon M, McLeod R, O’Connor B, Steinhart A, Greenberg G, Cohen Z (1993) Combination of ciprofloxacin and metronidazole in severe perineal Crohn’s disease. Can J Gastroenterol 7:571–573

    Google Scholar 

  42. Thia KT, Mahadevan U, Feagan BG et al (2009) Ciprofloxacin or metronidazole for the treatment of perianal fistulas in patients with Crohn’s disease: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis 15:17–24

    PubMed  Google Scholar 

  43. Korelitz BI, Present DH (1985) Favorable effect of 6-mercaptopurine on fistulae of Crohn’s disease. Dig Dis Sci 30:58–64

    CAS  PubMed  Google Scholar 

  44. Jeshion WC, Larsen KL, Jawad AF et al (2000) Azathioprine and 6-mercaptopurine for the treatment of perianal Crohn’s disease in children. J Clin Gastroenterol 30:294–298

    CAS  PubMed  Google Scholar 

  45. Pearson DC, May GR, Fick GH, Sutherland LR (1995) Azathioprine and 6-mercaptopurine in Crohn’s disease. A meta-analysis. Ann Intern Med 123:132–142

    CAS  PubMed  Google Scholar 

  46. Domenech E, Hinojosa J, Nos P et al (2005) Clinical evolution of luminal and perianal Crohn’s disease after inducing remission with infliximab: how long should patients be treated? Aliment Pharmacol Ther 22:1107–1113

    CAS  PubMed  Google Scholar 

  47. Colombel JF, Schwartz DA, Sandborn WJ et al (2009) Adalimumab for the treatment of fistulas in patients with Crohn’s disease. Gut 58:940–948

    PubMed Central  CAS  PubMed  Google Scholar 

  48. Hinojosa J, Gomollon F, Garcia S et al (2007) Efficacy and safety of short-term adalimumab treatment in patients with active Crohn’s disease who lost response or showed intolerance to infliximab: a prospective, open-label, multicentre trial. Aliment Pharmacol Ther 25:409–418

    CAS  PubMed  Google Scholar 

  49. Lichtiger S, Binion DG, Wolf DC et al (2010) The CHOICE trial: adalimumab demonstrates safety, fistula healing, improved quality of life and increased work productivity in patients with Crohn’s disease who failed prior infliximab therapy. Aliment Pharmacol Ther 32:1228–1239

    CAS  PubMed  Google Scholar 

  50. Linares L, Moreira LF, Andrews H, Allan RN, Alexander-Williams J, Keighley MR (1988) Natural history and treatment of anorectal strictures complicating Crohn’s disease. Br J Surg 75:653–655

    CAS  PubMed  Google Scholar 

  51. Homan WP, Tang C, Thorgjarnarson B (1976) Anal lesions complicating Crohn disease. Arch Surg 111:1333–1335

    CAS  PubMed  Google Scholar 

  52. Williams JG, Hughes LE (1990) Abdominoperineal resection for severe perianal Crohn’s disease. Dis Colon Rectum 33:402–407

    CAS  PubMed  Google Scholar 

  53. Pescatori M, Interisano A, Basso L et al (1995) Management of perianal Crohn’s disease. Results of a multicenter study in Italy. Dis Colon Rectum 38:121–124

    CAS  PubMed  Google Scholar 

  54. Morrison JG, Gathright JBJ, Ray JE, Ferrari BT, Hicks TC, Timmcke AE (1989) Surgical management of anorectal fistulas in Crohn’s disease. Dis Colon Rectum 32:492–496

    CAS  PubMed  Google Scholar 

  55. Bernard D, Morgan S, Tasse D (1986) Selective surgical management of Crohn’s disease of the anus. Can J Surg 29:318–321

    CAS  PubMed  Google Scholar 

  56. Lockhart-Mummery HE (1985) Anal lesions in Crohn’s disease. Br J Surg 72:S95–S96

    PubMed  Google Scholar 

  57. Pritchard TJ, Schoetz DJJ, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1990) Perirectal abscess in Crohn’s disease. Drainage and outcome. Dis Colon Rectum 33:933–937

    CAS  PubMed  Google Scholar 

  58. Makowiec F, Jehle EC, Becker HD, Starlinger M (1997) Perianal abscess in Crohn’s disease. Dis Colon Rectum 40:443–450

    CAS  PubMed  Google Scholar 

  59. White RA, Eisenstat TE, Rubin RJ, Salvati EP (1990) Seton management of complex anorectal fistulas in patients with Crohn’s disease. Dis Colon Rectum 33:587–589

    CAS  PubMed  Google Scholar 

  60. Goodsall DH, Miles WE (1900) Ano-rectal fistula. In: Goodsall DH, Miles WE (eds) Diseases of the anus and rectum. Longmans, Greens and Co., London, pp 92–137

    Google Scholar 

  61. Coremans G, Dockx S, Wyndaele J, Hendrickx A (2003) Do anal fistulas in Crohn’s disease behave differently and defy Goodsall’s rule more frequently than fistulas that are cryptoglandular in origin? Am J Gastroenterol 12:2732–2735

    Google Scholar 

  62. Fry RD, Shemesh EI, Kodner IJ, Timmcke A (1989) Techniques and results in the management of anal and perianal Crohn’s disease. Surg Gynecol Obstet 168:42–48

    CAS  PubMed  Google Scholar 

  63. Williamson PR, Hellinger MD, Larach SW, Ferrara A (1995) Twenty-year review of the surgical management of perianal Crohn’s disease. Dis Colon Rectum 38:389–392

    CAS  PubMed  Google Scholar 

  64. Fuhrman GM, Larach SW (1989) Experience with perirectal fistulas in patients with Crohn’s disease. Dis Colon Rectum 32:847–848

    CAS  PubMed  Google Scholar 

  65. Koganei K, Sugita A, Harada H, Fukushima T, Shimada H (1995) Seton treatment for perianal Crohn’s fistulas. Surg Today 25:32–36

    CAS  PubMed  Google Scholar 

  66. Keighley MR, Allan RN (1986) Current status and influence of operation on perianal Crohn’s disease. Int J Colorectal Dis 1:104–107

    CAS  PubMed  Google Scholar 

  67. Williams JG, Rothenberger DA, Nemer FD, Goldber SM (1991) Fistula-in-ano in Crohn’s disease. Results of aggressive surgical treatment. Dis Colon Rectum 34:378–384

    CAS  PubMed  Google Scholar 

  68. Winter AM, Banks PA, Petros JG (1993) Healing of transsphincteric perianal fistulas in Crohn’s disease using a new technique. Am J Gastroenterol 88:2022–2025

    CAS  PubMed  Google Scholar 

  69. van Dongen LM, Lubbers EJ (1986) Perianal fistulas in patients with Crohn’s disease. Arch Surg 121:1187–1190

    PubMed  Google Scholar 

  70. Lapidus A, Bernell O, Hellers G, Lofberg R (1998) Clinical course of colorectal Crohn’s disease: a 35-year follow-up study of 507 patients. Gastroenterology 114:1151–1160

    CAS  PubMed  Google Scholar 

  71. Hyder SA (2006) Fistulating anal Crohn’s disease: results of combined surgical and infliximab treatment. Dis Colon Rectum 49:1837–1841

    PubMed  Google Scholar 

  72. Sangwan YP, Schoetz DJJ, Murray JJ, Roberts PL, Coller JA (1996) Perianal Crohn’s disease. Results of local surgical treatment. Dis Colon Rectum 39:529–535

    CAS  PubMed  Google Scholar 

  73. Michelassi F, Melis M, Rubin M, Hurst RD (2000) Surgical treatment of anorectal complications in Crohn’s disease. Surgery 128:597–603

    CAS  PubMed  Google Scholar 

  74. Faucheron JL, Saint-Marc O, Guibert L, Parc R (1996) Long-term seton drainage for high anal fistulas in Crohn’s disease: a sphincter saving operation? Dis Colon Rectum 39:208–211

    CAS  PubMed  Google Scholar 

  75. Pearl RK, Andrews JR, Orsay CP et al (1993) Role of the seton in the management of anorectal fistulas. Dis Colon Rectum 36:573–579

    CAS  PubMed  Google Scholar 

  76. Nordgren S, Fasth S, Hulten L (1992) Anal fistulas in Crohn’s disease: incidence and outcome of surgical treatment. Int J Colorectal Dis 7:214–218

    CAS  PubMed  Google Scholar 

  77. Matos D, Lunniss PJ, Phillips Rk (1993) Total sphincter conservation in high fistula in ano: results of a new approach. Br J Surg 80:802–804

    CAS  PubMed  Google Scholar 

  78. Iesalnieks I, Gaertner WB, Glass H et al (2010) Fistula associated anal adenocarcinoma in Crohn’s disease. Inflamm Bowel Dis 16:1643–1648

    PubMed  Google Scholar 

  79. Thomas M, Bienkowski R, Vandermeer TJ, Trostle D, Cagir B (2010) Malignant transformation in perianal fistulas of Crohn’s disease: a systematic review of literature. J Gastrointest Surg 14:66–73

    PubMed  Google Scholar 

  80. Sonoda T, Hull T, Piedmonte MR, Fazio VW (2002) Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum 45:1622–1628

    PubMed  Google Scholar 

  81. Zimmerman DD, Delemarre JB, Gosselink MP, Hop WC, Briel JW, Schouten WR (2003) Smoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas. Br J Surg 90:351–354

    CAS  PubMed  Google Scholar 

  82. Jarrar A, Church J (2011) Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum 54:1537–1541

    PubMed  Google Scholar 

  83. McKee RF, Keenan RA (1996) Perianal Crohn’s disease—is it all bad news? Dis Colon Rectum 39:136–142

    CAS  PubMed  Google Scholar 

  84. Jones IT, Fazio VW, Jagelman DG (1987) The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum. Dis Colon Rectum 30:919–923

    CAS  PubMed  Google Scholar 

  85. Lewis P, Bartolo DC (1990) Treatment of trans-sphincteric fistulae by full thickness anorectal advancement flaps. Br J Surg 77:1187–1189

    CAS  PubMed  Google Scholar 

  86. Makowiec F, Jehle EC, Becker HD, Starlinger M (1995) Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn’s disease. Br J Surg 82:603–606

    CAS  PubMed  Google Scholar 

  87. Joo JS, Weiss EG, Nogueras JJ, Wexner SD (1998) Endorectal advancement flap in perianal Crohn’s disease. Am Surg 64:147–150

    CAS  PubMed  Google Scholar 

  88. Marchesa P, Hull TL, Fazio VW (1998) Advancement sleeve flaps for treatment of severe perianal Crohn’s disease. Br J Surg 85:1695–1698

    CAS  PubMed  Google Scholar 

  89. Mizrahi N, Wexner SD, Zmora O et al (2002) Endorectal advancement flaps: are they predictors of failure? Dis Colon Rectum 45:1616–1621

    PubMed  Google Scholar 

  90. Tozer PJ, Burling D, Gupta A, Phillips RK, Hart AL (2011) Review article: medical, surgical and radiological management of perianal Crohn’s fistulas. Aliment Pharmacol Ther 33:5–22

    CAS  PubMed  Google Scholar 

  91. O’leary DP, Milroy CE, Durdey P (1998) Definitive repair of anovaginal fistula in Crohn’s disease. Ann R Coll Surg Engl 80:250–252

    PubMed Central  PubMed  Google Scholar 

  92. Hull TL, Fazio VW (1997) Surgical approaches to low anovaginal fistula in Crohn’s disease. Am J Surg 173:95–98

    CAS  PubMed  Google Scholar 

  93. Ozuner G, Hull TL, Cartmill J, Fazio VW (1996) Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas. Dis Colon Rectum 39:10–14

    CAS  PubMed  Google Scholar 

  94. Simmang CL, Lacey SW, Huber PJJ (1998) Rectal sleeve advancement: repair of rectovaginal fistula associated with anorectal stricture in Crohn’s disease. Dis Colon Rectum 41:787–789

    CAS  PubMed  Google Scholar 

  95. Sher ME, Bauer JJ, Gelernt I (1991) Surgical repair of rectovaginal fistulas in patients with Crohn’s disease: transvaginal approach. Dis Colon Rectum 34:641–648

    CAS  PubMed  Google Scholar 

  96. Bauer JJ, Sher ME, Jaffin H, Present D, Gelerent I (1991) Transvaginal approach for repair of rectovaginal fistulae complicating Crohn’s disease. Ann Surg 213:151–158

    PubMed Central  CAS  PubMed  Google Scholar 

  97. Cintron JR, Park JJ, Orsay CP et al (2000) Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up. Dis Colon Rectum 43:944–949

    CAS  PubMed  Google Scholar 

  98. Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD (2002) A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum 45:1608–1615

    PubMed  Google Scholar 

  99. Zmora O, Mizrahi N, Rotholtz N et al (2003) Fibrin glue sealing in the treatment of perineal fistulas. Dis Colon Rectum 46:584–589

    PubMed  Google Scholar 

  100. Chung W, Ko D, Sun C, Raval MJ, Brown CJ, Phang PT (2010) Outcomes of anal fistula surgery in patients with inflammatory bowel disease. Am J Surg 199:609–613

    PubMed  Google Scholar 

  101. de Parades V, Far HS, Etienney I, Zeitoun JD, Atienza P, Bauer P (2010) Seton drainage and fibrin glue injection for complex anal fistulas. Colorectal Dis 12:459–463

    PubMed  Google Scholar 

  102. Ky AJ, Sylla P, Steinhagen R, Steinhagen E, Khaitov S, Ly EK (2008) Collagen fistula plug for the treatment of anal fistulas. Dis Colon Rectum 51:838–843

    PubMed  Google Scholar 

  103. Christoforidis D, Etzioni DA, Goldberg SM, Madoff RD, Mellgren A (2008) Treatment of complex anal fistulas with the collagen fistula plug. Dis Colon Rectum 51:1482–1487

    PubMed  Google Scholar 

  104. Schwandner O, Fuerst A (2009) Preliminary results on efficacy in closure of transsphincteric and rectovaginal fistulas associated with Crohn’s disease using new biomaterials. Surg Innov 16:162–168

    PubMed  Google Scholar 

  105. Safar B, Jobanputra S, Sands D, Weiss EG, Nogueras JJ, Wexner SD (2009) Anal fistula plug: initial experience and outcomes. Dis Colon Rectum 52:248–252

    PubMed  Google Scholar 

  106. Lichtiger S (2001) Healing of perianal fistulae by local injection of antibody to TNF. Gastroenterology 120(suppl 1):A621

    Google Scholar 

  107. Poggioli G, Laureti S, Pierangeli F et al (2005) Local injection of Infliximab for the treatment of perianal Crohn’s disease. Dis Colon Rectum 48:768–774

    CAS  PubMed  Google Scholar 

  108. Asteria CR, Ficari F, Bagnoli S, Milla M, Tonelli F (2006) Treatment of perianal fistulas in Crohn’s disease by local injection of antibody to TNF-alpha accounts for a favourable clinical response in selected cases: a pilot study. Scand J Gastroenterol 41:1064–1072

    CAS  PubMed  Google Scholar 

  109. Poggioli G, Laureti S, Pierangeli F et al (2010) Local injection of adalimumab for perianal Crohn’s disease: better than infliximab? Inflamm Bowel Dis 16:1631

    CAS  PubMed  Google Scholar 

  110. Tonelli F, Giudici F, Asteria CF (2012) Effectiveness and safety of local adalimumab injection in patients with fistulizing perianal Crohn’s disease: a pilot study. Dis Colon Rectum 55:870–875

    PubMed  Google Scholar 

  111. Loeffler T, Welsch T, Muehl S, Hinz U, Schmidt J, Kienle P (2009) Long-term success rate after surgical treatment of anorectal and rectovaginal fistulas in Crohn’s disease. Int J Colorectal Dis 24:521–526

    Google Scholar 

  112. Regueiro M, Mardini H (2003) Treatment of perianal fistulizing Crohn’s disease with infliximab alone or as an adjunct to exam under anesthesia with seton placement. Inflamm Bowel Dis 9:98–103

    PubMed  Google Scholar 

  113. Uchino M, Ikeuchi H, Bando T et al (2011) Long-term efficacy of infliximab maintenance therapy for perianal Crohn’s disease. World J Gastroenterol 17:1174–1179

    PubMed Central  PubMed  Google Scholar 

  114. El-Gazzaz G, Hull T, Church JM (2012) Biological immunomodulators improve the healing rate in surgically treated perianal Crohn’s fistulas. Colorectal Dis 14:1217–1223

    CAS  PubMed  Google Scholar 

  115. Sciaudone G, Di Stazio C, Limongelli P et al (2010) Treatment of complex perianal fistulas in Crohn disease: infliximab, surgery or combined approach. Can J Surg 53:299–304

    PubMed Central  PubMed  Google Scholar 

  116. Topstad DR, Panaccione R, Heine JA, Johnson DR, MacLean AR, Buie WD (2003) Combined seton placement, infliximab infusion, and maintenance immunosuppressives improve healing rate in fistulizing anorectal Crohn’s disease: a single center experience. Dis Colon Rectum 46:577–583

    PubMed  Google Scholar 

  117. van der Hagen SJ, Baeten CG, Soeters PB, Russel MG, Beets-Tan RG, van Gemert WG (2005) Anti-TNF-alpha (infliximab) used as induction treatment in case of active proctitis in a multistep strategy followed by definitive surgery of complex anal fistulas in Crohn’s disease: a preliminary report. Dis Colon Rectum 48:758–767

    PubMed  Google Scholar 

  118. Guidi L, Ratto C, Semeraro S et al (2008) Combined therapy with infliximab and seton drainage for perianal fistulizing Crohn’s disease with anal endosonographic monitoring: a single-centre experience. Tech Coloproctol 12:111–117

    CAS  PubMed  Google Scholar 

  119. Tanaka S, Matsuo K, Sasaki T et al (2010) Clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing Crohn’s disease: when and how were the seton drains removed? Hepatogastroenterology 57:3–7

    CAS  PubMed  Google Scholar 

  120. Talbot C, Sagar PM, Johnston MJ, Finan PJ, Burke D (2005) Infliximab in the surgical management of complex fistulating anal Crohn’s disease. Colorectal Dis 7:164–168

    CAS  PubMed  Google Scholar 

  121. Antakia R, Shorthouse AJ, Robinson K, Lobo AJ (2013) Combined modality treatment for complex fistulating perianal Crohn’s disease. Colorectal Dis 15:210–216

    CAS  PubMed  Google Scholar 

  122. Rasul I, Wilson SR, MacRae H, Irwin S, Greenberg GR (2004) Clinical and radiological responses after infliximab treatment for perianal fistulizing Crohn’s disease. Am J Gastroenterol 99:82–88

    CAS  PubMed  Google Scholar 

  123. Gligorijević V, Spasić N, Bojić D et al (2010) The role of pelvic MRI in assessment of combined surgical and infliximab treatment for perianal Crohn’s disease. Acta Chir Iugosl 57:89–95

    PubMed  Google Scholar 

  124. Karmiris K, Bielen D, Vanbeckevoort D et al (2011) Long-term monitoring of infliximab therapy for perianal fistulizing Crohn’s disease by using magnetic resonance imaging. Clin Gastroenterol Hepatol 9:130–136

    CAS  PubMed  Google Scholar 

  125. Savoye-Collet C, Savoye G, Koning E, Dacher JN, Lerebours E (2011) Fistulizing perianal Crohn’s disease: contrast-enhanced magnetic resonance imaging assessment at 1 year on maintenance anti-TNF-alpha therapy. Inflamm Bowel Dis 17:1751–1758

    CAS  PubMed  Google Scholar 

  126. Ng SC, Plamondon S, Gupta A et al (2009) Prospective evaluation of anti-tumor necrosis factor therapy guided by magnetic resonance imaging for Crohn’s perineal fistulas. Am J Gastroenterol 104:2973–2986

    CAS  PubMed  Google Scholar 

  127. Tozer P, Ng SC, Siddiqui MR et al (2012) Long-term MRI-guided combined anti-TNF-α and thiopurine therapy for Crohn’s perianal fistulas. Inflamm Bowel Dis 18:1825–1834

    PubMed  Google Scholar 

  128. Schwartz DA, White CM, Wise PE, Herline AJ (2005) Use of endoscopic ultrasound to guide combination medical and surgical therapy for patients with Crohn’s perianal fistulas. Inflamm Bowel Dis 11:727–732

    PubMed  Google Scholar 

  129. Gaertner WB, Decaini A, Mellgren A et al (2007) Does infliximab infusion impact results of operative treatment for Crohn’s perianal fistulas? Dis Colon Rectum 50:1754–1760

    PubMed  Google Scholar 

  130. Yamamoto T, Allan RN, Keighley MR (2000) Effect of fecal diversion alone on perianal Crohn’s disease. World J Surg 24:1258–1262

    CAS  PubMed  Google Scholar 

  131. Hong MKH, Lynch AC, Bell S et al (2010) Faecal diversion in the management of perianal Crohn’s disease. Colorectal Dis 13:171–176

    Google Scholar 

  132. Laukoetter MG, Mennigen R, Hannig CM et al (2011) Intestinal cancer risk in Crohn’s disease: a meta-analysis. J Gastrointest Surg 15:576–583

    PubMed  Google Scholar 

  133. Ogawa H, Haneda S, Shibata C et al (2013) Adenocarcinoma associated with perianal fistulas in Crohn’s disease. Anticancer Res 33:685–690

    PubMed  Google Scholar 

  134. Devon KM, Brown CJ, Burnstein M, McLeod RS (2009) Cancer of the anus complicating perianal Crohn’s disease. Dis Colon Rectum 52:211–216

    CAS  PubMed  Google Scholar 

  135. Cirincione E, Gorfine SR, Bauer JJ (2000) Is Hartmann’s procedure safe in Crohn’s disease? Report of three cases. Dis Colon Rectum 43:544–547

    CAS  PubMed  Google Scholar 

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Conflict of interest

Fiorenzo Botti, Alessandra Losco, Chiara Viganò, Barbara Oreggia, Matteo Prati and Ettore Contessini Avesani declare that they have no conflict of interest related to this article.

Informed consent

No patient information was included in this study. However, the authors have the patients’ consent to the publication of images that could potentially lead to their identification.

Human and animal studies

In connection with this study, the authors did not carry out any procedures involving humans or animals.

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Authors and Affiliations

  1. Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy

    F. Botti & E. Contessini Avesani

  2. UOC Chirurgia Generale e d’Urgenza, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy

    F. Botti, B. Oreggia, M. Prati & E. Contessini Avesani

  3. UO Medicina VI Epatologia e Gastroenterologia, A.O. San Paolo, Milan, Italy

    A. Losco

  4. UO Medicina Interna, Ospedale S. Famiglia Fatebenefratelli, Erba, Italy

    C. Viganò

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  1. F. Botti
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  2. A. Losco
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  3. C. Viganò
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  4. B. Oreggia
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  5. M. Prati
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  6. E. Contessini Avesani
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Correspondence to F. Botti.

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Botti, F., Losco, A., Viganò, C. et al. Imaging techniques and combined medical and surgical treatment of perianal Crohn’s disease. J Ultrasound 18, 19–35 (2015). https://doi.org/10.1007/s40477-013-0042-9

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  • DOI: https://doi.org/10.1007/s40477-013-0042-9

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