Perianal fistula in the course of Crohn's disease. It is an abnormal channel connecting the anal lumen to the skin of the perineal area. Typical symptoms of this disease are leakage of purulent contents from the anal area and itching and burning of the skin of the anal area. If the external opening of the fistula becomes overgrown, a perianal abscess (painful excoriation of the skin of the perineal area, often accompanied by fever) develops, the treatment of which requires prompt surgical intervention. Recurrent perianal abscesses and fistulas are typical of Crohn's disease.

DESCRIPTION OF THE COURSE OF THE PROPOSED MEDICAL PROCEDURE OR OPERATION

The operation is performed under general intravenous or regional anaesthesia (the anaesthetist will provide detailed information on the anaesthetic and its possible complications during the examination). Once the patient has been placed in a position that allows a full assessment of the anal area, the area is carefully examined. Once the external orifice(s) of the fistula channel has been located, the internal orifice of the fistula is found in the rectum or anus. Depending on the course of the fistula channel, we dissect it or, more commonly, insert a drainage thread into it. This is necessary for fistulas involving a larger section of the anal sphincter muscles responsible for holding stool and gas. If there are more external fistula orifices, it is necessary to insert more drainage threads or drains. In the case of deep perianal fistulas, it is sometimes necessary to place drains into the anal area. Due to the coexistence of Crohn's disease, the aim of surgical treatment is to ensure adequate drainage of the fistula channel and reduce the risk of perianal abscess formation and damage to the sphincter apparatus. In a large proportion of cases, complete healing of the fistula with Crohn's disease is not possible.

DESCRIPTION OF OTHER AVAILABLE TREATMENTS

Complementary to surgical treatment is drug therapy. In addition to standard anti-inflammatory treatment based on 5-aminosalicylic acid preparations (sulphasalazine, mesalazine) and corticosteroids, there is the possibility of biological therapy - intravenously administered preparations that reduce the body's inflammatory response. This method is effective in selected groups of patients. The majority of patients experience an exacerbation of their disease symptoms after therapy. In addition, this treatment is associated with a number of other complications. Your treating physician will provide you with additional information on the various methods of treating fistulas in Crohn's disease.