Curbside Consultation in IBD: 49 Clinical Questions, Second Edition

David T Rubin, MD; Sonia Friedman, MD; Francis A Farraye, MD MSc

Question 27: What Is Your First-Line Approach To The Diagnosis And Treatment Of Patients With Perianal Crohn’S Disease? (continued)

Natalie Nesmith, MD; David A. Schwartz, MD

Perianal Crohn’s disease (CD), or more specifically fistulizing CD, is one of the more dreaded complications for patients with this disease. If not treated aggressively from the onset, it can often negatively affect the patient’s quality of life in a dramatic way, secondary to pain or incontinence. In the worst cases, it can even result in proctectomy. To prevent these potential outcomes, we approach CD patients with perianal disease using a modified top-down approach, employing a multimodality (radiology, surgery, and medicine) treatment strategy (Figure 27-1). When a…