78 Steps Health Journal

Anorectal Stricture

Chronic anorectal abscesses, fistulae, ulcers or inflammation may lead to an anorectal stricture. Three varieties have been described:

1. Short, annular strictures less than 2 cm in length, resulting in diaphragmatic deformity.

2. Longer, tubular strictures.

3. Strictures secondary to "dysfunction" atrophy.

In a series of 44 patients, Linares et al. [29] reported approximately 50% of the strictures as being located in the rectum, 33% in the anus, and the remainder in the anorectum. They also found that most of these patients had coexisting proctitis or perianal disease. The majority of strictures are asymptomatic or well tolerated. If they become symptomatic, they may be incapacitating because of urgency, incontinence, tenesmus and difficulty with defecation. Mild disease may respond to medical treatment such as topical steroids, 5-aminosalicylic

Table 1. Stoma and proctectomy rate in Crohn's disease

Reference

No. of patients

No. of operations

Stoma rate

Proctectomy

Shivananda et al. (1989) [44] Harper and Fazio

Allan and Keighley

acid or systemic metronidazole. Non-invasive surgical management using gentle dilatation may be successful, particularly in cases of short diaphragmatic lesions. Repeat dilatations may be necessary until disease remission. Most symptomatic strictures are not cured with simple dilatation and may require faecal diversion or proctectomy [29, 30].

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