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 ].

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Tech Coloproctol.

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Br Med J.

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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.

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However, fistulas in CD may also develop, similar to sporadic fistulas, due to infection of the Hermann's anal glands.

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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.

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Research on topical tacrolimus in patients with perianal disease suggests possible efficacy in improving symptoms but not in inducing complete closure.

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The Parks classification categorizes perianal fistulas based on their relationship to the external and internal anal sphincters Figures 1 and 2.