PERIANAL CROHNS-DISEASE - IS IT ALL BAD-NEWS

PURPOSE: The outcome of treatment of perianal Crohn's disease was asse ssed in 127 patients. METHODS: A retrospective review of the case note s of 415 patients who were seen in the North East of Scotland between 1985 and 1989 was undertaken. RESULTS: A total of 127 of 415 patients with Crohn's disease had perianal involvement. In 56 patients, periana l disease was the presenting complaint. Ninety-nine of the 127 patient s had colonic involvement. Thirty-two were treated with metronidazole, and 41 were treated with azathioprine, with at least temporary improv ement in 91 and 68 percent, respectively. Seventy patients had treatme nt for fistula-in-ano, and in 50 percent of patients permanent healing was achieved. In general, treatment and outcome were largely related to the extent and severity of gut involvement. Proctectomy was perform ed in 32 patients (in 11 because of ongoing colonic disease). Only sev en patients had proctectomy solely because of perianal disease. Procte ctomy was necessary in 32 of 99 patients with colitis and perianal dis ease but in none of 28 patients without colonic involvement. Primary h ealing of the perineal wound was obtained in 17 patients, and only one patient has an unhealed perineal wound at the time of reporting. CONC LUSION: Perianal Crohn's disease does not inevitably lead to panprocto colectomy. Cautious surgery for fistula when rectal inflammation is qu iescent is worthwhile. Loss of bowel continuity is more likely when co litis coexists with perianal disease. Panproctocolectomy is often indi cated because of the combination of colitis and perianal disease rathe r than for perianal disease alone.