Abstract
Background
The aim of the study was a cross-sectional investigation into the types of anal fistulae in patients with Crohn’s disease using 3-dimensional endoanal ultrasonography.
Methods
The study population consisted of 45 patients with established Crohn’s disease referred in a 2-year period for treatment of anal fistula. The fistulae were classified according to the presence of three criteria: 1. bifurcation or secondary extension; 2. cross-sectional width ≥3 mm; and 3. content of hyperechoic secretions.
Results
The fistulae of 24 patients (53%) satisfied two or three criteria and were classified as true Crohn’s fistulae, while the fistulae of 21 patients satisfied one or none of the criteria and were the cryptoglandular type. The fistulae in the two or three criteria group had been in existence for 8.4 years on average and those in the cryptoglandular group for 4.5 years on average (P = 0.283). The corresponding numbers of previous operations for fistula were 5.7 (range 0–32) and 1.5 (range 0–6), respectively (P = 0.0211). The presence of colitis or proctitis was similar across the groups, but the perianal Crohn’s disease activity index was higher with a Crohn’s type of fistula (P = 0.0097). Also, a larger proportion had been treated with anti-TNF-monoclonal antibody (0.0169).
Conclusions
Endoanal ultrasonography was capable of discerning two subgroups of fistula in Crohn’s patients. These groups were clinically different indicating that the prospect of surgical cure is also different.
Similar content being viewed by others
References
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 98:2732–2735
Taxonera C, Schwartz DA, Garcia-Olmo D (2009) Emerging treatments for complex perianal fistula in Crohn’s disease. World J Gastroenterol 15:4263–4272
Kamm MA, Ng SC (2008) Perianal fistulizing Crohn’s disease: a call to action. Clin Gastroenterol Hepatol 6:7–10
Irvine EJ (1995) Usual therapy improves perianal Chron’s disease as measured by a new disease activity index. McMaster IBD study group. J Clin Gastroenterol 20:27–32
Caprioli F, Losco A, Viganò C et al (2006) Computer-assisted evaluation of perinanal fistual activity by means of anal ultrasound in patients with Crohn’s disease. Am J Gastroenterol 101:1551–1558
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
Ziech M, Felt-Bersma R, Stoker J (2009) Imaging of perianal fistulas. Clin Gastroenterol Hepatol 7:1037–1045
Van Koperen PJ, Safiruddin F, Bemelman WA, Slors JF (2009) Outcome of surgical treatment for fistula in ano in Crohn’s disease. Br J Surg 96:675–679
Soltani A, Kaiser AM (2010) Endorectal advancement flap for cryptoglandular or Crohn’s fistula-in-ano. Dis Colon Rectum 53:486–495
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Blom, J., Nyström, P.O., Gunnarsson, U. et al. Endoanal ultrasonography may distinguish Crohn’s anal fistulae from cryptoglandular fistulae in patients with Crohn’s disease: a cross-sectional study. Tech Coloproctol 15, 327–330 (2011). https://doi.org/10.1007/s10151-011-0719-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-011-0719-z