Crohn's Disease: The Complete Guide to Medical Management

Gary R. Lichtenstein, MD, FACP, FACG, AGAF

Chapter 33: Medical Management of Perianal Fistula (continued)

Tarun Misra, MD, FRCP(C); Richard N. Fedorak, MD, FRCP(C)

BACKGROUND Many of the people who suffer from Crohn’s disease, especially when it involves the colon, also have perianal problems. This comorbidity complicates an already difficult disease. Among the manifestations of perianal disease, perianal fistulas are the most common and pose the greatest management challenge. Assessment of functional and psychosocial problems should be a routine undertaking, as patients often are embarrassed to discuss this area and clinicians fail to question and examine thoroughly. However, the identification of perianal fistulas through diagnostic imaging…