Anorectal Crohn’s Disease
Crohn’s disease is an inflammatory condition of the gastrointestinal tract. Anorectal involvement occurs in more than a quarter of cases. Primary anorectal involvement includes a variety of disease entities. Most common are anal tags, fissures, ulcers, abscesses, fistulas, and strictures. Anorectal squamous carcinomas and adenocarcinomas occur less frequently. Symptoms are exceedingly variable and can range from mild annoyance caused by anal skin tags to chronic pain, sepsis, and fecal incontinence caused by complex fistulas and cavitating ulcerations. Effective treatment of anorectal Crohn’s disease requires a thorough understanding of the involved anatomy. This often requires anorectal examination under anesthesia as well as studies by magnetic resonant imaging or endorectal ultrasound. Surgical amelioration of perianal sepsis is always required. Therapy is often multimodal and involves a variety of agents including antibiotics, immunomodulators, and biologics. Surgical intervention needs to be exercised judiciously. Close collaboration between the surgeon, the gastroenterologist, and other specialists is mandatory. Diversion and proctectomy are required in many cases. Desired outcomes of therapy for anorectal Crohn’s disease should include complete healing when possible, maintenance of rectal function and continence, elimination of sepsis, and overall improvement in quality of life.