| Theme | Complication of Inflammatory Bowel Disease | |
|---|---|---|
| Title | Perianal Fistula and Carcinoma Arising from Perianal Fistula Complicating with Inflammatory Bowel Disease | |
| Publish Date | 2013/05 | |
| Author | Kazutaka Koganei | Surgical Department, Yokohama City Municipal Hospital |
| Author | Kenji Tasumi | Surgical Department, Yokohama City Municipal Hospital |
| Author | Ryo Futatsuki | Surgical Department, Yokohama City Municipal Hospital |
| Author | Hirosuke Kuroki | Surgical Department, Yokohama City Municipal Hospital |
| Author | Hideaki Kimura | Inflammatory Disease Center, Yokohama City University Medical Center |
| Author | Akira Sugita | Surgical Department, Yokohama City Municipal Hospital |
| [ Summary ] | Perianal fistulas are frequent manifestation of Crohn's disease. There are two types of fistula, one arises from deep ulcers caused by Crohn's disease in the rectum or anal canal. The other type consists of incidental fistulas following crypt glandular infection. After collecting a detail history and conducting clinical examinations for anal lesions, colonoscopies or barium (Gastrografin®) enema studies, MRI, CT or other modalities are employed to detect the fistulous tracts or abscess and evaluate other anorectal lesions, such as anorectal stenosis or rectal fistulas. Medical treatment with antibiotics, immunomodulators, and antitumor necrosis factor α therapy, as well as local surgical treatments, such as non-cutting seton drainage, are performed. Treatment for both intestinal and anorectal Crohn's disease is also necessary to control perianal fistulas. Despite treatment with medications and local surgical treatment, some patients need diversionary stomas or proctectomies. A number of case reports have indicated that the number of the carcinomas arising from perianal fistulas is increasing in Japan. Care must be taken in treating Crohn's disease patients with longstanding perianal fistulas. Approximately ten percent of patients with ulcerative colitis patients have perianal fistulas, mostly caused by crypt glandular infections. |
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