Objectives: To review the frequency, severity, course, and outcome of
perianal Crohn's disease in children and adolescents. Methods: Records
of 141 children and adolescents with Crohn's disease were reviewed. O
f these, 18 patients (eight female, 10 male) between 9 and 18 yr of ag
e (nine blacks and nine whites) had significant perianal disease. The
disease was classified on the basis of external appearance, degree of
inflammation, presence of infection or abscess formation, spread to vu
lva, loss of perineal body, and occurrence of anal canal stricture as
being mild, moderate, or severe. Results: Eight patients had severe in
volvement, whereas moderate and mild degree of perianal disease was se
en in six and four patients, respectively. Disease localization was as
follows: pancolitis, 12; ileocolitis, four; and left colitis, two. Th
erapy with Azulfidine or 5-amino salicylic acid preparation, local and
systemic steroids, metronidazole, immunosuppressives, and enteral and
/or parenteral nutrition was used in various combinations. Surgery was
necessary in eight patients: in four for management of anal canal str
icture. incision and drainage of abscess in two, total proctocolectomy
in one, and fecal diversion in an additional patient. Over a follow-u
p period ranging from 18 months to 15 yr, nine patients had partial im
provement, whereas in the rest, the disease either did not improve or
worsened. Conclusions: Severe, mutilating perianal Crohn's disease, ca
using significant tissue destruction, occurs in both sexes and is extr
emely refractory to treatment in the majority of patients. The outcome
in mild and moderate disease is better.