Many patients with anorectal Crohn's disease present other intestinal locations of the disease, requiring an evaluation of the colon and small bowel. The presence of proximal disease poses a therapeutic dilemma: early reports suggest that perianal conditions persist in the presence of proximal disease and improve only if proximal disease is resected [10,11]; however, other reports refute these findings and show no improvement in perianal disease after treatment of proximal disease [12].

Thus, the proximal intestinal tract should be evaluated but does not necessarily require surgery before treatment of perianal manifestations unless they are symptomatic. Surgical management of the perianal area is a challenge. Historically, surgeons were reluctant to perform surgery because of delayed wound healing and the risk of compromising sphincter competence. Alexander-Williams expressed a prevailing sentiment in 1974: "Faecal incontinence is the result of aggressive surgeons and not progressive disease." Advocates of this non-invasive approach, which included medicinal and hygienic management, considered that aggressive surgical procedures only created more complex problems [13,14].

In the late eighties, investigators found that a more aggressive but still limited surgical approach to perianal disease was possible [15, 16]. Two resolutions were adopted:

1. the management of a septic focus is an indication for surgery.

2. The sphincter should be preserved if a patient is continent [15].

One multicentre study reviewing treatment of patients with perianal Crohn's disease shows medical treatment to be curative in only a few patients, whereas surgical procedures were curative in more than half of the patients [17]. A role for both approaches exists and success is attributed to careful patient selection, limited surgical intervention, and improved perioperative medical management [18,19].

Was this article helpful?

0 0
Mole Removal

Mole Removal

Moles, warts, and other unsightly irregularities of the skin can be bothersome and even embarrassing. They can be removed naturally... Removing Warts and Moles Naturally! If you have moles, warts, and other skin irregularities that you cannot cover up affecting the way you look, you can have them removed. Doctors can be extremely expensive. Learn the natural ways you can remove these irregularities in the comfort of your own home.

Get My Free Ebook

Post a comment