Anorectal Crohn’s Disease
8 results
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Benign Disease- A 45-year-old man presents to your office with complaints of bloating, constipation, and intermittent diarrhea over the last 3 months. He has a 20-year history of Crohn’s disease and is currently receiving biologic therapy. On physical examination, he is mildly distended, without peritonitis. Colonoscopy confirms a sigmoid stricture that cannot be traversed. The most appropriate treatment is:
- A 70-year-old man with history of perianal Crohn’s disease and 15-year history of an anal fistula presents to establish care. On examination, he has a right anterior anal fistula that appears chronic in nature. What is the best next step in management?
- A 35-year-old woman is taken to the operating room for a proctocolectomy with end ileostomy for Crohn’s disease–related colonic dysplasia. What is the most appropriate surgical management of the perineal dissection?
- A 50-year-old man with a history of ulcerative colitis presents for follow-up 6 months after emergent total abdominal colectomy with end ileostomy. He complains of pain and persistent drainage from the perianal area. Ileoscopy is normal. The pathology report from his surgical specimen demonstrates full-thickness inflammation and granulomas. What is the most appropriate next step?
- Anorectal Disease
- A 34-year-old man has a constant, “dull ache” of the lower rectum accompanied by intermittent spontaneous rectal discharge. Imaging reveals a supralevator abscess with direct extension through the levators to the ischiorectal fossa. What is the next step in treatment?
- A 40-year-old woman with a history of Crohn's disease presents to your office with quiescent proctitis and a 4-mm rectovaginal fistula just above the anorectal ring. There is no appreciable sphincter defect. What is your best recommendation for repair?
- A 30-year-old man presents for evaluation of a nontender ulcer near the anus that has been present for the past few weeks. He has engaged in anal receptive intercourse recently with a new partner. On examination, a 1-cm slightly raised lesion with an erythematous center is noted near the anal canal. It is not tender to palpation. What is the appropriate treatment?
- Pelvic Floor