Surgical treatment of anoperineal lesions in Crohn's disease

The treatment of anoperineal crohn disease [APCD] is difficult and still a controversy subject. We reviewed 31 cases, which were 19 men. The middle age was 37 years. The lesions were represented by ulcerations in 14 cases, the fistulas in 28 cases and 2 cases of stenosis of the rectum. An hemorroidary disease was associated at nine patients with 1 case of malignant degeneration. The intestinal location was present at 63% of the cases and mostly in a distal part of the bowel. The biopsy of the APCD had objectives a granuloma in 15 cases and a malpighien carcinoma in one case. The treatment consisted, in addition to the treatment of the intestinal disease, on the hygienic and dietary prescription, metronidazol in 100% of the cases, ciprofloxacin in 7 cases. A treatment by immunosuppressor has been instituted for 2 patients. The surgical treatment done for 14 patients consisted in a drainage of the fistulas through fistulotomy [6 cases], incision of abscess [4 cases], progressive fistulotomy with elastic drainage [2 cases], resection of a fibrous diaphragm [1 case] and abdomino-perineal amputation in one case. The APCD is often invalidating with a real therapeutic problem: how can we treat the infectious process without compromising the sphincterian function