Perianal abscess in Crohn's disease
Tóm tắt
PURPOSE: Perianal disease is frequent in patients with Crohn's disease, and many of these patients will eventually have abscess formation. In a prospective follow-up study, we evaluated factors influencing the occurrence and recurrence of perianal abscesses. METHODS: Of 126 consecutive patients with perianal Crohn's disease seen regularly in an outpatient clinic, 61 (48.4 percent) had at least one perianal abscess (mean follow-up, 32±17 months). In all, 110 episodes of an abscess with 145 anatomically distinct abscesses were documented. RESULTS: The occurrence of first abscesses was dependent on the type of anal fistula (ischiorectal, 73 percent; transsphincteric, 50 percent; superficial, 25 percent;P
< 0.02). Surgical therapy consisted of seton drainage (34 percent), mushroom catheter drainage (49 percent), or incision and drainage (29 percent) and led to inactivation in all patients. Cumulative two-year recurrence rates after the first and second abscess were 54 and 62 percent, respectively. Abscess recurrence was less frequent in patients with a stoma (13
vs.
60 percent in patients without stoma after two years) and in patients with superficial anal fistulas (0
vs.
55 percent/56 percent in patients with transsphincteric/ischiorectal fistulas). Only two abscesses recurred within one year after removal of seton drainage, whereas 13 abscesses recurred with the seton still in place. Neither intestinal nor rectal activity of Crohn's disease significantly influenced the occurrence of an abscess. During the study period, only two patients developed partial stool incontinence. CONCLUSION: Development of perianal abscesses in Crohn's disease depends on the fecal stream and the anatomic type of anal fistula. Seton and catheter drainage are safe and highly effective in treatment. Long-term use of setons to prevent recurrent abscesses is not supported by our data.
Tài liệu tham khảo
Makowiec F, Jehle EC, Starlinger M. Clinical course of perianal fistulas in Crohn's disease. Gut 1995;37:696–701.
Williamson PR, Hellinger MD, Larach SW, Ferrara A. Twenty-year review of the surgical management of perianal Crohn's disease. Dis Colon Rectum 1994;38:389–92.
Keighley MR, Allan RN. Current status and influence of operation on perianal Crohn's disease. Int J Colorectal Dis 1986;1:104–7.
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.
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.
Allan A, Keighley MR. Management of perianal Crohn's disease. World J Surg 1988;12:198–202.
Alexander-Williams J, Buchmann P. Perianal Crohn's disease. World J Surg 1980;4:203–8.
Ramanujam PS, Prasad ML, Abcarian H, Tan AB. Perianal abscesses and fistulas: a study in 1023 patients. Dis Colon Rectum 1984;27:593–7.
Makowiec F, Jehle EC, Becker HD, Starlinger M. Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn's disease. Br J Surg 1995;82:603–6.
Makowiec F, Laniado M, Jehle EC, Claussen CD, Starlinger M. Magnetic resonance imaging in perianal Crohn's disease. Inflammatory Bowel Diseases 1995;1:256–65.
Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg 1976;63:1–12.
Jakobovits J, Schuster MM. Metronidazole therapy for Crohn's disease and associated fistulae. Am J Gastroenterol 1984;79:533–40.
Bernstein LH, Frank MS, Brandt LJ, Boley SJ. Healing of perineal Crohn's disease with metronidazole, Gastroenterology 1980;79:357–65.
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;168:42–9.
Heuman R, Bolin T, Sjödahl R, Tagesson C. The incidence and course of perianal complications and arthralgia after intestinal resection with restoration of continuity for Crohn's disease. Br J Surg 1981;68:528–30.
Sher ME, Bauer JJ, Gorphine S, Gelernt I. Low Hartmann's procedure for severe anorectal Crohn's disease. Dis Colon Rectum 1992;35:975–80.
Harper PH, Kettlewell MG, Lee EC. The effect of split ileostomy on perianal Crohn's disease. Br J Surg 1982;89:608–10.
Zelas P, Jagelman DG. Loop ileostomy in the management of Crohn's colitis in the debilitated patient. Ann Surg 1980;191:164–8.
Sohn N, Korelitz BI, Weinstein MA. Anorectal Crohn's disease: definite surgery for fistulas and recurrent abscesses. Am J Surg 1980;139:394–7.
Van Dongen LM, Lubbers EJ. Perianal fistulas in patients with Crohn's disease. Arch Surg 1986;121:1187–90.