Perianal Crohn's Disease-A Surgical Perspective

Perianal complications associated with Crohn's disease are often the most challenging and difficult to treat of all the manifestations of this condition. Up to 75% of Crohn's disease patients can have perianal involvement. Although perianal symptoms can present at any time, it is not uncommon for this to be the first expression of the disease. The diagnostic workup depends on whether the diagnosis of Crohn's disease is already established. The most useful studies are endoscopy, endoanal ultrasonography, magnetic resonance imaging, and an examination under anesthesia. Crohn's disease in the perianal area can manifest as skin tags, anal fissures, anorectal strictures/stenosis, abscesses, and fistulae. Despite the appearance of these lesions, up to 25% are asymptomatic. Because of the significant morbidity associated with surgical therapy in Crohn's disease, asymptomatic lesions are best left untreated because chronic nonhealing wounds and incontinence can result. Unfortunately, the success of surgical therapy for perianal Crohn's disease is limited. Surgery is most successful when the overall disease state is quiescent and when there is minimal inflammation in the perianal region and anal canal.