Abstract
PURPOSE: A retrospective analysis of 48 patients treated over a 20-year period (March 1973–April 1993) was undertaken to assess the results of our practice of early surgical intervention in suppurative complications of perianal Crohn's disease. METHODS: All patients were either seen in the office within the last six months or contacted by phone. RESULTS: The average age of our patients was 30 years at initial diagnosis. Thirty-four patients (71 percent) initially presented with intestinal disease and four (8 percent) with only perianal disease. Thirteen patients (27 percent) initially presented with simultaneous intestinal and perianal disease. The various fistulas at initial presentation included 8 intersphincteric (17 percent), 14 transphincteric (29 percent), 11 complex or multiple (23 percent), 5 rectovaginal (10 percent), and 2 unclassified, for a total of 40 patients. Eight patients (17 percent) presented with only an abscess. Eighty five percent of our patients healed after their first procedure, with an average time to heal of 2.8 months. Thirteen (27 percent) patients had recurrences after initial healing of their wounds. The mean time to recurrence after healing was 5.25 years. Fifty-four percent of our recurrences (7 patients) were treated by incision and drainage of an abscess only. Seven of 13 recurrences healed after the second procedure (54 percent), and 5 of 6 healed after a third procedure (83 percent). Only seven (14 percent) of our patients underwent a proctocolectomy during the study period, through September, 1993. Our overall probability of avoiding proctectomy and healing perineal wounds of 86 percent is consistent with published literature. CONCLUSIONS: Early aggressive surgical management of suppurative complications of perianal Crohn's disease before complex management problems ensue results in a high incidence of healing and a low risk of subsequent proctectomy.
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References
Allan A, Keighley MR. Management of perianal Crohn's disease. World J Surg 1988;12:198–202.
Fry RD, Shemesh EI, Kodner IJ, Timmcke A. Techniques and results in the management of anal and perianal Crohn's disease. Surg Gynecol Obstet 1989;168:42–8.
Fuhrman GM, Larach SW. Experience with perirectal fistulas in patients with Crohn's disease. Dis Colon Rectum 1989;32:847–8.
Wolff BG, Culp CE, Beart RW, Ilstrup DM, Ready RL. Anorectal Crohn's disease: a long-term perspective. Dis Colon Rectum 1985;28:709–11.
Williams DR, Coller JA, Corman ML, Nugent FW, Veidenheimer MC. Anal complications in Crohn's disease. Dis Colon Rectum 1981;24:22–4.
Van Dongen LM, Lubbers EC. Perianal fistulas in patients with Crohn's disease. Arch Surg 1986;121:1187–90.
Williams JG, Rothenberger DA, Nemer FD, Goldberg SM. Fistula-in-ano in Crohn's disease: results of aggressive surgical treatment. Dis Colon Rectum 1991;34:378–84.
Buchmann P, Keighley MR, Allan RN, Thompson H, Alexander-Williams J. Natural history of perianal crohn's disease: ten year follow-up: a plea for conservatism. Am J Surg 1980;140:642–4.
Pritchard TJ, Schoetz DJ, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC. Perirectal abscess in Crohn's disease: drainage and outcome. Dis Colon Rectum 1990;33:933–7.
Levien DH, Surrell J, Mazier WP. Surgical treatment of anorectal fistula in patients with Crohn's disease. Surg Gynecol Obstet 1989;169:133–6.
Morrison JG, Gathright JB, Ray JE, Ferrari BT, Hicks TC, Timmcke AE. Surgical management of anorectal fistulas in Crohn's disease. Dis Colon Rectum 1989;32:492–6.
Sohn N, Korelitz BI, Weinstein MA. Anorectal Crohn's disease: definitive surgery for fistulas and recurrent abscesses. Am J Surg 1980;139:394–7.
Alexander-Williams J, Buchmann P. Perianal Crohn's disease. World J Surg 1980;4:203–8.
Ecker KW, Schmid T, Lindemann W. Anorectal Crohn's disease-II: prognosis after drainage operation for acute suppurative infections. Colo-proctology 1993;6:346–51.
Ramanujam PS, Prasad ML, Abcarian H, Tan AB. Perianal abscesses and fistulas: a study of 1023 patients. Dis Colon Rectum 1984;27:593–7.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994
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Williamson, P.R., Hellinger, M.D., Larach, S.W. et al. Twenty-year review of the surgical management of perianal Crohn's disease. Dis Colon Rectum 38, 389–392 (1995). https://doi.org/10.1007/BF02054227
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DOI: https://doi.org/10.1007/BF02054227