TY - JOUR
T1 - Clinical Course of Isolated Recurrent, Persistent Complex Perianal Fistulas Without Luminal Crohn’s Disease
T2 - A Multicenter Case Series of 24 Patients
AU - Fiske, Hannah W.
AU - Tse, Chung Sang
AU - Al-Bawardy, Badr
AU - Magavi, Pooja
AU - Konijeti, Gauree Gupta
AU - Mao, Eric
AU - Fine, Sean
AU - Parian, Alyssa
AU - Lazarev, Mark
AU - Shah, Samir A.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/10/1
Y1 - 2024/10/1
N2 - Background: Isolated complex perianal fistulas, without luminal evidence of inflammatory bowel disease in the gastrointestinal tract, pose diagnostic and treatment dilemmas for gastroenterologists and colorectal surgeons. For patients who develop recurrent complex fistulas, a presumptive diagnosis of Crohn’s disease may be made. It is unclear whether these cases of isolated perianal disease in the absence of luminal inflammation truly represent isolated severe cryptoglandular fistulas or rather an early presentation of Crohn’s disease. We aimed to investigate the clinical course and outcomes of patients with isolated complex perianal fistulas. Methods: In this retrospective multicenter case series across 6 institutions in the United States, we report the clinical course of patients with isolated recurrent complex perianal fistulas, including their diagnostic evaluation, medical and surgical therapies, and clinical outcomes. Results: All patients (n = 24) required incision and drainage of perirectal abscesses. The majority received setons (n = 19, 79%), more intensive surgical interventions (n = 15, 62.5%, including fistulotomy/sphincterotomy, advancement flap, and ligation of the intersphincteric fistula tract), antibiotics (n = 17, 71%), and biologic therapy (n = 16, 67%). Nine patients (37.5%) underwent a combined medical-surgical approach with biologics and intensive surgical intervention. Despite surgical and/or medical management, active symptomatic complex perianal fistulas persisted in 58% (n = 14) of patients at follow-up (median 5.5 years, interquartile range 2.5-10 years); symptom remission was achieved in 21% (n = 5), and fistula closure in 21% (n = 5). Conclusions: These cases highlight a multidisciplinary and multimodal approach when treating isolated complex perianal fistulas and their propensity to persist despite the incorporation of advanced therapies. Lay Summary In this retrospective multicenter case series, we report the clinical course of 24 patients with isolated complex perianal fistulas without luminal evidence of inflammatory bowel disease. These cases suggest the importance of a multidisciplinary and multimodal approach to treatment.
AB - Background: Isolated complex perianal fistulas, without luminal evidence of inflammatory bowel disease in the gastrointestinal tract, pose diagnostic and treatment dilemmas for gastroenterologists and colorectal surgeons. For patients who develop recurrent complex fistulas, a presumptive diagnosis of Crohn’s disease may be made. It is unclear whether these cases of isolated perianal disease in the absence of luminal inflammation truly represent isolated severe cryptoglandular fistulas or rather an early presentation of Crohn’s disease. We aimed to investigate the clinical course and outcomes of patients with isolated complex perianal fistulas. Methods: In this retrospective multicenter case series across 6 institutions in the United States, we report the clinical course of patients with isolated recurrent complex perianal fistulas, including their diagnostic evaluation, medical and surgical therapies, and clinical outcomes. Results: All patients (n = 24) required incision and drainage of perirectal abscesses. The majority received setons (n = 19, 79%), more intensive surgical interventions (n = 15, 62.5%, including fistulotomy/sphincterotomy, advancement flap, and ligation of the intersphincteric fistula tract), antibiotics (n = 17, 71%), and biologic therapy (n = 16, 67%). Nine patients (37.5%) underwent a combined medical-surgical approach with biologics and intensive surgical intervention. Despite surgical and/or medical management, active symptomatic complex perianal fistulas persisted in 58% (n = 14) of patients at follow-up (median 5.5 years, interquartile range 2.5-10 years); symptom remission was achieved in 21% (n = 5), and fistula closure in 21% (n = 5). Conclusions: These cases highlight a multidisciplinary and multimodal approach when treating isolated complex perianal fistulas and their propensity to persist despite the incorporation of advanced therapies. Lay Summary In this retrospective multicenter case series, we report the clinical course of 24 patients with isolated complex perianal fistulas without luminal evidence of inflammatory bowel disease. These cases suggest the importance of a multidisciplinary and multimodal approach to treatment.
KW - inflammatory bowel disease
KW - isolated perianal Crohn’s disease
KW - perianal fistula
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UR - http://www.scopus.com/inward/citedby.url?scp=85211994351&partnerID=8YFLogxK
U2 - 10.1093/crocol/otae065
DO - 10.1093/crocol/otae065
M3 - Article
C2 - 39679162
AN - SCOPUS:85211994351
SN - 2631-827X
VL - 6
JO - Crohn's and Colitis 360
JF - Crohn's and Colitis 360
IS - 4
M1 - otae065
ER -