Introduction: This is our initial experience in the surgical management of perianal fistulizing Crohn’s disease (PFCD). This is a cross-sectional review of consecutive Crohn’s disease patients presenting with perianal fistula who were surgically managed between November 2020 to September 2024.
Objectives. 1) To present profiles of patients with PFCD; 2) To classify patients with PFCD using the American Gastroenterological Association (AGA) classification; and 3) To describe our approach to management.
Methods: Only patients diagnosed with Crohn’s disease presenting with anal fistulas were included. Patient demographics, classification of anal fistula using the AGA classification were described. Pelvic MRIs were done in all patients to define the fistula tracts and detect the presence or absence of concomitant abscess. For each patient, the number of external and internal openings, and the type of surgical management were described.
Results: Twenty-nine patients with PFCD were surgically managed. There were 15 males and 14 females, ages ranging from 16 to 47 years (median age of 26.5 years). Six patients (21%) had prior history of anal operation for anal abscess and/or fistula. Using the AGA classification, all patients had complex fistula. On physical examination, 14 patients (48%) had two or more external openings. One-third of female patients had ano-vaginal fistula. At the time of surgery, two or more internal openings were demonstrated in more than half of patients (55%). Draining setons were performed in all patients.
Conclusion: Awareness of the possible association of inflammatory bowel disease to complex anal fistula offers an additional differential diagnosis to this challenging problem, and may alter approaches to disease management.