Acta Endoscopica

, 37:285 | Cite as

Le traitement des fistules anales dans la maladie de Crohn

  • O. Dewit
Article
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Résumé

Le risque pour un patient souffrant de maladie de Crohn (MC) de développer à un moment donné de son évolution une fistule anale (FAP) est évalué par certains à plus de 40 %. Ces FAP sont particulièrement fréquentes lorsque la MC atteint la partie distale du tube digestif et constituent une des situations les plus difficiles à traiter avec d’ailleurs une réponse souvent incomplète. Le but du traitement est de soulager les symptômes, d’améliorer la qualité de vie en essayant de guérir les lésions, de prévenir les récidives et de réduire le risque de destruction sphinctérienne. Les méthodes utilisées pour diagnostiquer et classer les trajets fistuleux avec une grande efficacité sont: l’examen anorectal sous anesthésie, la résonance magnétique pelvienne et l’écho-endoscopie anorectale. Le trajet anatomique de la fistule, l’activité et la sévérité clinique de la maladie sous-jacente ont conduit à distinguer des fistules simples et complexes. La prise en charge de ces FAP requiert une approche combinée, médicale et chirurgicale, afin d’optimiser le traitement et d’obtenir les taux de succès les plus élevés. Une fistule simple est habituellement traitée par antibiotiques et fistulotomie. Une fistule complexe est souvent traitée par la pose de séton, par antibiotiques, par l’azathioprine et dans beaucoup de cas par des anti-TNF comme l’infliximab. Dans un deuxième temps, la colle biologique ou l’abaissement d’un lambeau rectal peut être proposé.

Mots-clés

fistule anale maladie de Crohn 

Treatment of anal fistula in Crohn’s disease

Summary

Crohn’s disease (CD) is complicated by perianal fistulas in up to 40 % of patients at some time during the course of their disease. Perianal fistulas are particularly frequent when the distal portion of the digestive tract is involved and are one of the most difficult sequelae of Crohn’s disease, with an often incomplete response to treatment. The goal of the treatment is symptom relief and improved quality of life in an attempt to cure the lesions, prevent relapse, and reduce the risk of sphincter destruction. Modalities used to diagnose and classify Crohn’s perianal fistulas tracks with a high diagnostic accuracy include examination under anaesthesia, pelvic magnetic resonance imaging and endoanal ultrasonography. The classification of the fistula as simple or complex depends on the anatomical fistula track, the activity and the clinical severity of the disease. A combined medical and surgical approach in the management of such patients is the optimal treatment bearing higher success rate. A simple fistula is usually treated by antibiotics and fistulotomy. A complex fistula is often treated by noncutting setons, antibiotics, azathioprine and in many cases by anti-TNF agents such as infliximab. In a second step, fibrin glue or rectal advancement flap can be considered.

Key-words

anal fistula Crohn’s disease 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • O. Dewit
    • 1
  1. 1.Service de gastro-entérologieCliniques universitaires Saint Luc, UCLBruxellesBelgique

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