ABSTRACT
BACKGROUND: The presence of perianal fistulas in Crohn's disease [CD] denotes increased disease aggressiveness. We studied the epidemiology and clinical outcomes of perianal CD [PCD] using the Hong Kong territory-wide IBD Registry [HKIBDR]. METHODS: Consecutive patients with PCD were identified from the HKIBDR, and disease characteristics, treatments, and outcomes were analysed. The risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. RESULTS: Among 981 patients with CD with 10530 patient-years of follow-up, 283 [28.8%] had perianal involvement, of which 120 [42.4%] were as first presentation. The mean age at diagnosis of PCD was 29.1 years, and 78.8% were male. The median follow-up duration was 106 months (interquartile range [IQR]: 65-161 months]. Perianal fistula [84.8%] and perianal abscess [52.7%] were the two commonest forms. Male, younger age at diagnosis of CD, and penetrating phenotypes were associated with development of PCD in multivariate analysis. Of 242 patients with fistulizing PCD, 70 [29.2%] required ≥5 courses of antibiotics, and 98 [40.5%] had ≥2 surgical procedures. Nine patients required defunctioning surgery and 4 required proctectomy. Eighty-four patients [34.7%] received biologics. Cumulative probabilities for use of biologics were 4.7%, 5.8%, and 8.6% at 12 months, 36 months, and 96 months, respectively, while the probabilities for surgery were 67.2%, 71.6%, and 77.7%, respectively. Five mortalities were recorded, including 2 cases of anal cancer, 2 CD-related complications, and one case of pneumonia. CONCLUSION: Over 40% of CD patients presented with perianal disease at diagnosis. Patients with PCD had poor outcome, with young age of onset, multiple antibiotic use, and repeated surgery.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Anus Diseases , Biological Products/therapeutic use , Colectomy , Crohn Disease , Rectal Fistula , Adult , Age Factors , Anus Diseases/complications , Anus Diseases/diagnosis , Anus Diseases/epidemiology , Colectomy/adverse effects , Colectomy/methods , Colectomy/statistics & numerical data , Crohn Disease/complications , Crohn Disease/diagnosis , Crohn Disease/epidemiology , Female , Hong Kong/epidemiology , Humans , Kaplan-Meier Estimate , Male , Outcome Assessment, Health Care , Patient Care Management/methods , Patient Care Management/statistics & numerical data , Rectal Fistula/diagnosis , Rectal Fistula/epidemiology , Rectal Fistula/etiology , Risk Factors , Severity of Illness Index , Sex FactorsABSTRACT
A 33-year-old pregnant woman presented with peritonitis at the right iliac fossa. Preoperative ultrasonography identified an 8-cm tubular structure at the tender point that was mistaken as appendicitis. Emergency operation finally confirmed a 12-cm giant Meckel's diverticulum with genuine inflammation and imminent perforation. The patient made an uneventful recovery after Meckel's diverticulectomy.
