Anorectal disorders affect many patients with Crohn's disease. Clinical manifestations range from asymptomatic skin tags to severe, debilitating perineal destruction and sepsis. Surgical management must be conservative and must focus on draining septic foci if present, preserving sphincter function and palliating symptoms. Medical management has shown some success in improving symptoms but has not yet been

Fig. 9. Algorithm for treatment of perineal Crohn's disease

able to ameliorate most perineal complaints quickly with long lasting effects. Many new and exciting treatment modalities are being investigated, and it is hoped that more effective approaches to these complex and difficult problems will be found.

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