Management for Perianal Lesions in Crohn's Disease.

概要

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Analyrsis of 52 patients of Crohn's disease treated in our department was carried out. Forty-two (80.8%) of these cases had some perianal lesions, and perianal fistula was the most common perianal complication (34/42). In ileocolic type, complicated or resistant fistula had 68.2% incidence and simple fistula had 36.4% incidence. Seven of 11 patients with simple fistula preceeding the intestinal lesion were operated on and satisfactory results were obtained. Six of 9 simple fistulae following intestinal lesion required surgical treatment, and 4 of them were improved. Six of 14 patients with complicated perianal fistula eventually had splitting ileostomy. Seton suture was applied to 7 of 14 patients with complicated fistula, and 2 cases were markedly improved. As for the treatment of Crohn's primary perianal lesions, elemental diet therapy for some severe cases to alleviate the intestinal inflammation should be plannes. If such a systemic therapy fails, surgical excision of proximal intestine becomes necessary. For simple perianal fistula, surgical removal can be carried out resulting in almost complete cure during remission. For complexed fistula, we emphasize the usefulness of seton suture to drain and simplify the complicated fistular tracts. Severe cases such as rectourethral fistula and high-sphincteric fistula often require fecal diversion.
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