THE VALUE OF HUGHES-CARDIFF CLASSIFICATION IN THE MANAGEMENT OF PERIANAL CROHNS-DISEASE

Purpose: the aim of this study was to assess the value of Hughes' path ogenic classification in the prognosis and management of perianal Croh n's disease (CD). Patients and methods: this classification differenti ates between purely inflammatory lesions and their mechanical or septi c complications, and defines the presence of ulceration (U), fistula ( F) and stricture (S), which are assigned a score of 0, 1 or 2 accordin g to the severity and associated conditions, proximal intestinal invol vement and disease activity (A, P and D). Of a series of 96 patients w ith CD, 12 underwent 16 procedures involving anesthesia to treat sympt omatic anal lesions, Patients presenting with severe pain were explore d and treated by surgical drainage or, in cases in which there was no demonstrable sepsis, by gentle dilation or infiltration with steroids. For superficial, nonspecific fistulas, conventional fistulotomy was p erformed, and long-term seton drainage was implanted for complex fistu las, Strictures were treated by gentle dilation. Uncontrolled sepsis o r proctocolitis was managed by proximal stoma creation or proctocolect omy. Results: the association of cavitating ulcers (U2) and contiguous active rectal involvement (P1) was a contraindication for rectal pres ervation, making proctectomy or stoma creation the most feasible thera peutic option. The etiology of most, but not all, complex fistulas (F2 ) was the progressive cavitation of U2, whilst F1 was either of crypto glandular origin or the result of epithelialized fissures (U1). The tr eatment was also adjusted to this association, and it was confirmed th at most of the severe lesions (F2 and S2) were secondary to U2. Conclu sions: Hughes' pathogenic classification: I) makes it possible to set up an easily stored registry of anal and perianal Crohn's disease; 2) identifies predefined lesions, allowing the individualization of thera peutic procedures and the comparison of results, and 3) provides progn ostic information.