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Clin Colon Rectal Surg 2025; 38(02): 148-159
DOI: 10.1055/s-0044-1786377
Review Article

How to Approach the Difficult Perineum in Crohn's Disease

Authors

  • Emily Rinebold

    1   Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York

  • Alex L. Huang

    1   Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York

  • Sue J. Hahn

    1   Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
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Abstract

Crohn's disease (CD) is a chronic, inflammatory bowel disease with a wide range of presentations, including perianal disease. Presentation is variable, ranging from skin tags to complex fistulas, strictures, and nonhealing wounds. Symptoms of perianal CD can be devastating and may impact quality of life. Optimal management requires coordinated medical and surgical therapy. When possible, conservative treatment of perianal disease should be attempted. However, surgical treatment is often required, and some patients may ultimately require total proctocolectomy with permanent diversion due to the severity of disease. Even with close attention and treatment, disease can be recurrent, and complications of treatment are sometimes worse than the initial presentation. Novel treatments, including use of mesenchymal stem cells and autologous fat grafting, hold some promise, but are not yet widely available. Thorough knowledge of treatment options, careful patient selection, coordination between medical and surgical providers, and setting realistic expectations are important in the successful treatment of difficult perineal CD.

Keywords

Crohn's disease - fistulizing Crohn's disease - perianal fistula - nonhealing perineal wound - proctectomy


Publication History

Article published online:
07 May 2024

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