Chidi VN, Schwartz DA, et al.
Expert review of gastroenterology & hepatology. Date of publication 2015 Jun 1;volume 9(6):797-806.
1. Expert Rev Gastroenterol Hepatol. 2015 Jun;9(6):797-806. doi:
10.1586/17474124.2015.1031110. Epub 2015 Mar 30.
Imaging of perianal fistulizing Crohn's disease.
Chidi VN(1), Schwartz DA.
Author information:
(1)Division of Gastroentorology, Hepatology and Nutrition, Vanderbilt University
Medical Center, Nashville, TN, USA.
Perianal fistula is a complication of Crohn's disease that carries a high
morbidity. It is a channel that develops between the lower rectum, anal canal
and perianal or perineal skin. The development of perianal fistulas typically
connotes a more aggressive disease phenotype and may warrant escalation of
treatment to prevent poor outcomes over time. Based on fistula anatomy, debris
can form inside these tracts and cause occlusion, which subsequently leads to
abscess formation, fever and malaise. The clinical presentation is often with
complaints of pain, continuous rectal drainage of fecal matter as well as
malodorous discharge. Considering that the presence of fistulas often indicates
refractory and aggressive disease, early identification of its presence is
important. Some patients may not have the classic symptoms of fistulizing
disease at presentation and others may have significant scarring and/or pain
from previous fistulizing episodes, which can make an accurate assessment on
physical exam alone problematic. As a result, utilizing diagnostic imaging is
the best means of identifying the early signs of perianal fistulas or abscess
formation in these patients. Several imaging modalities exist which can be used
for diagnosis and management. Endoscopic ultrasound and pelvic MRI are
considered the most useful in establishing the diagnosis. However, a combination
of multiple imaging modalities and/or examination under anesthesia is probably
the most ideal. Incomplete characterization of the fistula tract(s) extent or
the presence of abscess carries a high morbidity and far-reaching personal
expense for the patient - promoting worsening of the disease.
DOI: 10.1586/17474124.2015.1031110
PMID: 25816833 [Indexed for MEDLINE]
