Techniques in Coloproctology

, Volume 21, Issue 9, pp 683–691 | Cite as

Anoperineal lesions in Crohn’s disease: French recommendations for clinical practice

  • D. Bouchard
  • L. Abramowitz
  • G. Bouguen
  • C. Brochard
  • A. Dabadie
  • V. de Parades
  • M. Eléouet-Kaplan
  • N. Fathallah
  • J.-L. Faucheron
  • L. Maggiori
  • Y. Panis
  • F. Pigot
  • P. Rouméguère
  • A. Sénéjoux
  • L. Siproudhis
  • G. Staumont
  • J.-M. Suduca
  • B. Vinson-Bonnet
  • J.-D. Zeitoun



Anoperineal lesion (APL) occurrence is a significant event in the evolution of Crohn’s disease (CD). Management should involve a multidisciplinary approach combining the knowledge of the gastroenterologist, the colorectal surgeon and the radiologist who have appropriate experience in this area. Given the low level of evidence of available medical and surgical strategies, the aim of this work was to establish a French expert consensus on management of anal Crohn’s disease. These recommendations were led under the aegis of the Société Nationale Française de Colo-Proctologie (SNFCP). They report a consensus on the management of perianal Crohn’s disease lesions, including fistulas, ulceration and anorectal stenosis and propose an appropriate treatment strategy, as well as sphincter-preserving and multidisciplinary management.


A panel of French gastroenterologists and colorectal surgeons with expertise in inflammatory bowel diseases reviewed the literature in order to provide practical management pathways for perianal CD. Analysis of the literature was made according to the recommendations of the Haute Autorité de Santé (HAS) to establish a level of proof for each publication and then to propose a rank of recommendation. When lack of factual data precluded ranking according to the HAS, proposals based on expert opinion were written. Therefore, once all the authors agreed on a consensual statement, it was then submitted to all the members of the SNFCP. As initial literature review stopped in December 2014, more recent European or international guidelines have been published since and were included in the analysis.


MRI is recommended for complex secondary lesions, particularly after failure of previous medical and/or surgical treatments. For severe anal ulceration in Crohn’s disease, maximal medical treatment with anti-TNF agent is recommended. After prolonged drainage of simple anal fistula by a flexible elastic loop or loosely tied seton, and after obtaining luminal and perineal remission by immunosuppressive therapy and/or anti-TNF agents, the surgical treatment options to be discussed are simple seton removal or injection of the fistula tract with biological glue. After prolonged loose-seton drainage of the complex anal fistula in Crohn’s disease, and after obtaining luminal and perineal remission with anti-TNF ± immunosuppressive therapy, surgical treatment options are simple removal of seton and rectal advancement flap. Colostomy is indicated as a last option for severe APL, possibly associated with a proctectomy if there is refractory rectal involvement after failure of other medical and surgical treatments. The evaluation of anorectal stenosis of Crohn’s disease (ARSCD) requires a physical examination, sometimes under anesthesia, plus endoscopy with biopsies and MRI to describe the stenosis itself, to identify associated inflammatory, infectious or dysplastic lesions, and to search for injury or fibrosis of the sphincter. Therapeutic strategy for ARSCD requires medical–surgical cooperation.


Crohn’s disease Anoperineal lesions Anal fistulas Abscess Anal stenosis Guidelines Recommendations 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This type of study does not need ethical approval.

Informed consent

This type of study does not need informed consent.


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • D. Bouchard
    • 1
  • L. Abramowitz
    • 2
  • G. Bouguen
    • 3
  • C. Brochard
    • 3
  • A. Dabadie
    • 4
  • V. de Parades
    • 5
  • M. Eléouet-Kaplan
    • 1
  • N. Fathallah
    • 5
  • J.-L. Faucheron
    • 6
  • L. Maggiori
    • 7
  • Y. Panis
    • 7
  • F. Pigot
    • 1
  • P. Rouméguère
    • 8
  • A. Sénéjoux
    • 9
  • L. Siproudhis
    • 3
    • 10
  • G. Staumont
    • 11
  • J.-M. Suduca
    • 11
  • B. Vinson-Bonnet
    • 12
  • J.-D. Zeitoun
    • 13
  1. 1.Service de ProctologieHôpital Bagatelle, Maison de Santé Protestante BagatelleTalenceFrance
  2. 2.Proctologie médico-chirurgicalehôpital Bichat Claude-BernardParisFrance
  3. 3.Service des maladies de l’appareil digestifCHU PontchaillouRennesFrance
  4. 4.CHU Pontchaillou, CHU hôpital SudRennesFrance
  5. 5.Service de proctologie médico-chirurgicale, institut Léopold-Bellangroupe hospitalier Saint-JosephParisFrance
  6. 6.Unité de chirurgie colo-rectale, service de chirurgie digestive et de l’urgencehôpital Michallon, CHUGAGrenobleFrance
  7. 7.Service de chirurgie colo-rectale, pôle des maladies de l’appareil digestifhôpital Beaujon, université Paris 7ClichyFrance
  8. 8.Clinique Tivoli-DucosBordeauxFrance
  9. 9.CHP Saint-GrégoireSaint-GrégoireFrance
  10. 10.Inserm U991, service de gastro-entérologie, université de Rennes 1CHU PontchaillouRennesFrance
  11. 11.Clinique Saint-Jean-LanguedocToulouseFrance
  12. 12.Service de chirurgie viscérale et digestiveCHI, Poissy-St-Germain-en-LayeParisFrance
  13. 13.Service de proctologie médico-interventionnelleParisFrance

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