Abstract
Perianal disease is a frequent manifestation of Crohn's disease and occasionally is the presenting symptom. However, most lesions are or become asymptomatic and remain so for many years. A series of 109 patients with perianal fissures and fistulas has been followed for 10 years. Fourteen have died, 7 from unrelated disorders. Ten have had an excision of the rectum but only 5 for perianal disease. Of the remaining 85 patients, 24 asymptomatic patients were not reexamined, and 61 were investigated extensively by sigmoidoscopy biopsy or manometry. Many fissures and most fistulas had healed, but some had progressed to some degree of anal stenosis, usually asymptomatic. A very conservative policy is proposed.
Résumé
Les lésions péri-anales sont fréquentes dans la maladie de Crohn. Elles peuvent être le premier signe de la maladie. Mais la plupart d'entre elles sont ou deviennent asymptomatiques et peuvent le rester pendant plusieurs années. Nous avons suivi pendant 10 ans 109 malades atteints de fissures ou fistules anales. Quatorze patients sont décédés, 7 d'entre eux d'affections sans relation avec le Crohn. Dans 10 cas, une amputation du rectum a été réalisée, mais les lésions anales ne constituaient l'indication de cette exérèse que dans 5 cas. Sur les 85 cas restants, 24, sans aucun symptome, n'ont pas été réexaminés, 61 ont été étudiés par rectoscopie, biopsie ou manométrie. De nombreuses fissures et la majorité des fistules étaient cicatrisées; certaines avaient entraîné une sténose anale, en général modérée et asymptomatique. Nous estimons donc que le traitement doit être conservateur.
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Alexander-Williams, J., Buchmann, P. Perianal Crohn's disease. World J. Surg. 4, 203–207 (1980). https://doi.org/10.1007/BF02393577
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DOI: https://doi.org/10.1007/BF02393577