Crohns and anal fistula. Fistulae originate by an epithelial defect caused by inflammation whose repair is impaired because the migratory potential of colonic lamina propria fibroblasts is reduced in CD[ 5 ].
There is an attempt nowadays to offer patients with high and complex fistulas, besides the aforementioned palliative management, definitive treatment with sphincter-preserving procedures such as mucosal advancement or dermal island flaps, the use of glue dressed and undressed ladies plugs, video assisted anal fistula treatment, ligation of inter-sphincteric track, and vacuum assisted closure.
However, fistulas in CD may also develop, similar to sporadic fistulas, due to infection of the Hermann's anal glands.
The main aim of the treatment is alleviation of severe pain by incision and hot wet cunts of abscesses concomitant with fistulas with preservation of proper sphincter function.
Research on topical tacrolimus in patients with perianal disease suggests possible efficacy in improving symptoms but not in inducing complete closure.
AmEditor E- Editor:
The Parks classification categorizes perianal fistulas based on their relationship to the external and internal anal sphincters Figures 1 and 2.