Perianal disease is a common manifestation of Crohn disease (CD) that results in significant morbidity and decreased quality of life. Despite several medical and surgical options, complex perianal CD remains difficult to treat. Before the advent of biologic therapy, antibiotics were the mainstay of medical treatment. Infliximab remains the most well-studied medical therapy for perianal disease. Surgical interventions are limited by the risk of nonhealing wounds and potential incontinence. When treatment options fail, fecal diversion or proctectomy may be necessary. Stem cell therapies may offer improved results and seem to be safe, but are not yet widely used.
Key points
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Perianal Crohn’s disease (CD) is notoriously difficult to treat and often requires a multidisciplinary team of gastroenterologists, surgeons, and radiologist to best determine the management of the patient.
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Medical options for perianal CD most commonly include antibiotic therapy and biologic therapy.
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The primary surgical treatment is drainage of sepsis and placement of a seton for ongoing drainage.
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Many other surgical options, such as fistulotomy or advancement flaps, are not feasible if there is evidence of impaired wound healing or the presence of proctitis.
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Emerging stem cell–based therapies are promising, with safety and efficacy shown in several clinical trials.
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