Crohn's disease: bowel resection to protect the proctium in severe perianal disease?

Patients with anal Crohn's disease generally have a bad prognosis. Up to 50 % end up with an anus praeter or proctectomy. Many of these young people de velop psychological and social problems causing them to become invalids. Lo cal surgery and conservative therapy in such aggressive cases of Crohn's di sease presenting with recurring perianal fistulae and abscesses are often u nsuccessful; the destruction of the proctium continues. The purpose of our study was to look at the outcome of our patients with regard to these aspec ts. We included all 56 patients suffering from Crohn's disease treated at o ur clinic from 1984 until 1991 in a retrospective study and focused on the 13 patients with anal manifestation. The mean follow-up was 15.8 years (3-2 8 years). Often there was no improvement of perianal disease without resect ion of the involved bowel, especially in cases where both the colon and the rectum were affected. Anal destruction went on. Seven of the 13 patients s uffering from anal complications finally received an anus praeter, An previ ous bowel-resection or the construction of a temporary anus praeter seem to be necessary to protect the proctium irrespective of abdominal symptoms in patients with recurrent severe perianal Crohn's disease.