Anal fissure in Crohn's disease: A plea for aggressive management
Tóm tắt
PURPOSE: This study was undertaken to identify clinical characteristics, natural history, and results of medical and surgical treatment of anal fissures in Crohn's disease. METHODS: This is a retrospective review of patients with Crohn's disease and anal fissure. RESULTS: Of the 56 study patients, 49 (84 percent) had symptomatic fissures. Fissures were most commonly (66 percent) located in the posterior midline, and 18 patients (32 percent) had multiple fissures. Fissures healed in one-half of patients treated medically. Factors predictive of successful medical treatment included male gender, painless fissure, and acute fissure. Of 15 patients, 10 (67 percent) treated surgically healed. Fissures in seven of eight patients (88 percent) who underwent anorectal procedures healed compared with fissures in only three of seven patients (43 percent) who underwent proximal intestinal resection. In the group of 50 patients with complete follow-up studies, an anal abscess or fistula from the base of an unhealed fissure developed in 13 patients (26 percent). More fissures healed after anorectal surgery (88 percent) than after medical treatment alone (49 percent;P=0.05) or after abdominal surgery (29 percent;P=0.03). CONCLUSION: This series documents that unhealed fissures frequently progress to more ominous anal pathologic disease. Judicious use of internal sphincterotomy appears to be safe for fissures unresponsive to medical treatment.
Tài liệu tham khảo
Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis: pathologic and clinical entity. JAMA 1932;99:1323–9.
Williams DR, Coller JA, Corman ML, Nugent FW, Veidenheimer MC. Anal complications in Crohn's disease. Dis Colon Rectum 1981;24:22–4.
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.
Pritchard TJ, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC. Perirectal abscess in Crohn's disease: drainage and outcome. Dis Colon Rectum 1990;33:933–7.
Sweeney JL, Ritchie JK, Nicholls RJ. Anal fissure in Crohn's disease. Br J Surg 1988;75:56–7.
Corman ML. Colon and rectal surgery. Philadelphia: JB Lippincott, 1989.
Fielding JF. Perianal lesions in Crohn's disease. J R Coll Surg Edinb 1972;17:32–7.
Hobbiss JH, Schofield PF. Management of perianal Crohn's disease. J R Soc Med 1982;75:414–7.
Wolff BG, Culp CE, Beart RW Jr, Ilstrup DM, Ready RL. Anorectal Crohn's disease: a long term perspective. Dis Colon Rectum 1985;28:709–11.
Bernard D, Morgan S, Tassé D. Selective surgical management of Crohn's disease of the anus. Can J Surg 1986;29:318–21.
Lockhart-Mummery HE. Crohn's disease: anal lesions. Dis Colon Rectum 1975;18:200–2.
Khubchandani IT, Reed JF. Sequelae of internal sphincterotomy for chronic fissure in ano. Br J Surg 1989;76:431–4.
Rankin GB, Watts HD, Melnyk CS, Kelley ML Jr. National Cooperative Crohn's Disease Study: extraintestinal manifestations and perianal complications. Gastroenterology 1979;77(4 Pt 2):914–20.
Wolkomir AF, Luchtefeld MA. Surgery for symptomatic hemorrhoids and anal fissures in Crohn's disease. Dis Colon Rectum 1993;36:545–7.
Marks CG, Ritchie JK, Lockhart-Mummery HE. Anal fistulas in Crohn's disease. Br J Surg 1981;68:525–7.
Baker WN, Milton-Thompson GJ. Management of anal fistulae in Crohn's disease. J R Soc Med 1974;67:58.
Watts JM, Bennett RC, Goligher JC. Stretching of anal sphincters in treatment of fissure-in-ano. BMJ 1964;2:342–3.
Allan A, Keighley MR. Management of perianal Crohn's disease. World J Surg 1988;12:198–202.
Gordon PH, Vasilevsky CA. Symposium on outpatient anorectal procedures: lateral internal sphincterotomy: rationale, technique and anesthesia. Can J Surg 1985;28:228–30.
Sohn N, Korelitz BI. Local operative treatment of anorectal Crohn's disease. J Clin Gastroenterol 1982;4:395–9.
Morrison JG, Gathright JB Jr, Ray JE, Ferrari BT, Hicks TC, Timmcke AE. Surgical management of anorectal fistulas in Crohn's disease. Dis Colon Rectum 1989;32:492–6.
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.
Bergstrand O, Ewerth S, Hellers G, Holmström B, Ullman J, Wallberg P. Outcome following treatment of anal fistulae in Crohn's disease. Acta Chir Scand 1980;500(Suppl):43–4.