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Perianal abscess in Crohn's disease
F Makowiec1, E C Jehle, H D Becker
1Department of Surgery, Eberhard-Karls-University, Tübingen, Germany.
Diseases of the Colon and Rectum
|April 1, 1997
Summary
Perianal abscesses in Crohn's disease are influenced by fistula type and fecal stream. Drainage methods like setons are effective, but long-term use for recurrence prevention is not supported by this study.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Inflammatory Bowel Disease Research
Background:
- Perianal disease is a common complication in Crohn's disease patients.
- Abscess formation is a frequent and challenging manifestation of perianal Crohn's disease.
Purpose of the Study:
- To investigate factors influencing the initial occurrence and subsequent recurrence of perianal abscesses in Crohn's disease.
- To evaluate the effectiveness of different surgical drainage techniques for perianal abscesses.
Main Methods:
- Prospective follow-up study of 126 consecutive patients with perianal Crohn's disease.
- Documentation of 110 abscess episodes and 145 distinct abscesses over a mean follow-up of 32 months.
- Analysis of factors including fistula type, surgical treatment, stoma presence, and Crohn's disease activity.
Main Results:
- Abscess occurrence correlated with anal fistula type (ischiorectal 73%, transsphincteric 50%, superficial 25%).
- Surgical drainage (seton, catheter, incision) led to abscess inactivation in all patients.
- Two-year recurrence rates were 54% after the first and 62% after the second abscess; recurrence was lower with stomas and superficial fistulas.
- Seton drainage removal was associated with lower recurrence compared to setons left in place.
Conclusions:
- Fecal stream and anal fistula anatomy are key determinants of perianal abscess development in Crohn's disease.
- Seton and catheter drainage are safe and effective for treating perianal abscesses.
- Long-term seton use does not appear to prevent recurrent abscesses effectively.