Perianal Crohn's disease in children and adolescents

To review the frequency, severity, course, and outcome of perianal Crohn's disease in children and adolescents.

Records of 141 children and adolescents with Crohn's disease were reviewed. Of these, 18 patients (eight female, 10 male) between 9 and 18 yr of age (nine blacks and nine whites) had significant perianal disease. The disease was classified on the basis external appearance, degree of inflammation, presence of infection or abscess formation, spread to vulva, loss of perineal body, and occurrence of anal canal stricture as being mild, moderate, or severe.

Eight patients had severe involvement, whereas moderate and mild degree of perianal disease was seen in six and four patients, respectively. Disease localization was as follows: pancolitis, 12; ileocolitis, four; and left colitis, two. Therapy with Azulfidine or 5-amino salicylic acid preparation, local and systemic steroids, metronidazole, immunosuppressives, and enteral and/or parenteral nutrition was used in various combinations. Surgery was necessary in eight patients: in four for management of anal canal stricture, incision and drainage of abscess in two, total proctocolectomy in one, and fecal diversion in an additional patient. Over a follow-up period ranging from 18 months to 15 yr, nine patients had partial improvement, whereas in the rest, the disease either did not improve or worsened.

Severe, mutilating perianal Crohn's disease, causing significant tissue destruction, occurs in both sexes and is extremely refractory to treatment in the majority of patients. The outcome in mild and moderate disease is better.