Anorectal Crohn’s Disease
6 results
1 - 6
Anorectal Disease- A 24-year-old woman reports feculent vaginal discharge 8 months after spontaneous vaginal delivery complicated by a 4th-degree perineal laceration, which was previously repaired. Physical examination reveals a 3-mm rectovaginal fistula 2 cm proximal to the anal verge with significant thinning of the perineal body and a palpable sphincter defect anteriorly. Endoanal ultrasound confirms a 90° defect of the external sphincter at the anterior midline. The best next step in management is
- A 35-year-old woman presents to your office with recurrent perianal and inguinal pustular lesions and nodules with severe, extensive scarring and tunnel formation with ongoing drainage. The colonoscopy is normal, and she has no gastrointestinal symptoms. What is the best treatment to prevent recurrence?
- A 36-year-old patient was diagnosed with Crohn’s disease of the terminal ileum 4 years ago. She is currently in remission on infliximab; however, she is concerned about anal skin outgrowth that is frequently irritated. Physical examination reveals a 1.2-cm round anal skin tag that is soft, nontender with a smooth surface. Anoscopy shows normal appearing anorectal mucosa without evidence of perianal abscess or fistula. The most appropriate next step in management for this patient is
- Benign Disease
- A 32-year-old female patient with Crohn’s disease presents with anal pain. She takes infliximab. On examination, there are large skin tags with an anal fistula draining pus and a 3 x 3 cm area of localized induration and fluctuance. The best next step in her management is
- A 19-year-old woman diagnosed with severe Crohn’s proctosigmoiditis 18 months ago suffers from debilitating perianal pain, swelling, discharge, and incontinence. She has undergone numerous anorectal operations including several incision and drainage procedures and seton placements for three separate fistulas, including one with a supralevator extension. She currently has three setons and a mushroom catheter in place with significant ulceration in the anal canal. In addition to prolonged courses of antibiotics, she had been on infliximab for 12 months prior to being on ustekinumab for the past 6 months without improvement. What is the best next course of action?
- A 55-year-old man presents with abdominal pain and rectal bleeding. He has a 20-year history of Crohn’s proctocolitis and has perianal disease. He was treated with infliximab for 5 years but developed anti–tumor necrosis factor (TNF) antibodies. He had an allergic reaction to adalimumab. He has been on usketinumab for the past year with minimal improvement. You drained two prior perirectal abscesses and placed setons in the past 2 years. He currently has minimal complaints from the indwelling setons. A recent colonoscopy confirmed the persistence of chronic active proctosigmoiditis without evidence of dysplasia on multiple biopsies. He reports signficant disruption of his life and work and "wants this disease controlled, even if it means an ostomy." On physical examination, the abdominal is soft and minimally tender. Anorectal examination shows a well-controlled transphincteric fistula with seton without evidence of sepsis. Which of the following surgical options is most appropriate for this patient?