Anoperineal Lesions of Crohn's Disease: About 55 Cases

Anoperineal lesions (APL) are common manifestations of Crohn's disease (CD). They are observed in more than 50% of patients. They affect about one in two patients and can precede luminal disease in nearly 30 %. Rarely isolated, LAPs are associated with luminal disease, often rectal, in 75 to 92 % of cases. The existence of LAP is a prognostic criterion for the severity of Crohn's disease. One distinguishes, classically, three types of elementary lesions: fistulas, ulcerations and inflammatory pseudo marisques. The medico-surgical management of LAP MC requires a correct evaluation of the lesions by a meticulous clinical examination, by a pelvic MRI or an endo-anal ultrasound. At the end of this assessment, the management of LAPMC requires collaboration between the gastroenterologist, the proctologist and the surgeon. Management must be considered urgently in the event of an abscess and in the long term to spare sphincter function and heal the perineal disease. The objective of our work is to show the different anoperineal manifestations of CD observed in our department and their management. Retrospective study from January 2010 to December 2019 including 55 patients operated for an anoperineal lesion of CD. Proctological surgery was the treatment of choice in case of APL revealing CD. In the case of LAP associated with intestinal CD, the surgical indication is only posed in more than half. Medical treatment (antibiotic, immunosuppressants and infliximab) was instituted. Anoperineal lesions require specific management in addition to the management of bowel disease. They affect the prognosis and even the quality of life of patients.