Abstract: Despite significant advances in the treatment of luminal inflammatory bowel disease, the treatment of perianal fistulas remains a clinical challenge. Perianal fistulas are traditionally described using the Parks classification based on their relationship to the external and internal anal sphincters. Traditional therapy for perianal fistulas focuses on antibiotics such as metronidazole or ciprofloxacin. However, medical management has expanded over the years to include immunomodulators and, most recently, biologic agents. Newer techniques such as intrafistulous biologic injections are also being explored as potentially effective treatments for patients with fistulizing disease. Fistulas associated with CD can form between any segment of the intestine and either the skin or an adjacent organ, such as a contiguous loop of bowel, the bladder, or the vagina.
Fistulas: What You Need to Know About a Common Side Effect of Crohn’s | Everyday Health
For most people, these are very difficult and embarrassing to discuss, as they can result in bleeding, infections and the loss of control over one's bowels. The anus is the external opening through which feces are expelled from the body. Just inside the anus are a number of small glands. If one of these glands become blocked, an abscess—an infected cavity—may form. An anal abscess is usually treated by surgical drainage, although some drain spontaneously. About 50 percent of these abscesses may develop into a fistula, in which a small tunnel connects the infected gland inside the anus to an opening on the skin around the anus.
Perianal Fistulas in Patients With Crohn’s Disease, Part 1: Current Medical Management
We respect your privacy. Her condition was so severe that she needed emergency proctocolectomy surgery removal of the colon and rectum , and she was put on biologics. She developed a fistula, an abnormal opening that forms in the wall of the intestine and connects to other tissues or organs in the body.
A multidisciplinary approach of gastroenterologist, colorectal surgeon and radiologist is necessary for its management. A correct diagnosis, based on endoscopy, magnetic resonance imaging, endoanal ultrasound and examination under anesthesia, is crucial for perianal fistula treatment. Available medical and surgical therapies are discussed in this review, including new local treatment modalities that are under investigation. Disease location, age at diagnosis, fistula type, presence or absence of abscesses and intestinal strictures may influence the natural history of perianal CD[ 3 ].