How To Identify Perianal Fistulas
Perianal fistulas cause significant morbidity and diminish patients’ quality of life. Consequences of perianal fistulas include perianal drainage, pain, abscess formation, dyschezia, dyspareunia, and fecal incontinence. The National Benefit Authority . The identification and classification of perianal fistulas in Crohn’s disease is essential to providing safe and effective treatment for this patient population.
Clinicians should have a high index of suspicion for perianal fistulas in any patient suffering from Crohn’s disease. Consequently, all patients should be asked about symptoms that might suggest perianal disease. Symptoms include perianal drainage (purulent or enteric material), discomfort (including dyspareunia and dyschezia), and swelling. Perianal fistulas can occur with or without active disease involving the rectosigmoid region. It is important to inquire about symptoms that might suggest active inflammation, including diarrhea with or without blood, rectal urgency, tenesmus, incontinence, and abdominal discomfort, as well as systemic symptoms of fever, night sweats, and weight loss. In addition, extraintestinal manifestations, including asymmetric large joint arthritis and skin lesions such as pyoderma gangrenosum, uveitis, and oral ulcers, may be a clue to active Crohn’s disease, even in the patient with few or no bowel symptoms.
A perianal and rectal examination should be performed routinely in patients with Crohn’s disease. cheap longboards . The clinician should first inspect the perianal region for evidence of induration and erythema, fistulous tract openings, multiple or eccentric anal fissures, ulcerations, and/or large, broad-based skin tags. In the presence of fistulous openings, gentle compression adjacent to the orifice may result in the expulsion of purulent or enteric material suggesting active inflammation of the tract. Pain and induration on digital ano-rectal examination should raise suspicion for perianal infection, with or without an organized abscess. The presence of perianal fluctuance suggests the presence of an abscess cavity. Digital rectal examination is also important for identification of strictures and internal openings of fistulas that sometimes can be as large as a centimeter or more in diameter. When perianal disease is found, the clinician should keep the differential diagnosis in mind, including hidradenitis suppurativa, sexually transmitted diseases, squamous cell carcinoma, tuberculosis, and surgery or trauma to the perianal area. sitebrokers . In particular, hidradenitis suppurativa may be confused with complex fistulizing perianal Crohn’s disease. The correct diagnosis is made on examination under anesthesia by probing of the cutaneous tracts and demonstrating that they only traverse to the subdermal space and do not communicate with the rectum or other parts of the digestive tract.
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