Contemporary opinions on diagnosis and treatment of anal abscesses and fistulas in the course of Crohn's disease
Journal Title: Gastroenterologia Polska - Year 2007, Vol 14, Issue 5
Abstract
Fistulas and abscesses of the anuscaused by Crohn's disease (CD) constitute a therapeutic problem due to low effectiveness of conservative and surgical treatment as well as recurrent type of disease. Epidemiological data related to anal form of CD are divergent and range from 5% to as much as 80%, including over 40% of patients suffering from abscesses and fistulas. Fistulas in CD are usually more complicated anatomically and more complex than crypt originating fistulas. Frequently fistulas are branched, multipleand have more than one internal orifice, what is rarely seen in crypt originating fistulas. Quite often they simulate multiple fistulas with many external orifices that connect, however, in one common canal leadingto single crypt. Fistulas in CD, contrary to crypt originating fistulas, may be painful for the patient. Knowledge related to treatment of CD is continually changing. Treatment of fistulas in the course of CD may be conservative and/or surgical. Authors have discussed current preoperative diagnostic guidelines, presenting the transrectal ultrasonography, if possible supplemented with magnetic resonance as the "gol-den standard". They have also presented current directions in conservative and surgical treatment of anal fistulas based on up-to-date literature review. Despite the optimistic reports, especially concerning the conservative treatment of fistulas with systemically or locally administered infli-ximab, the authorsstress that until now, there is no absolutely reliable method to treat Crohn's fistulas. This suggests that each patient with anal manifestation of CD should be dealt with individually, having in mind that such patients require interdisciplinary care.
Authors and Affiliations
Małgorzata Kołodziejczak, Krzysztof Bielecki
Keywords
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