Anoperineal Disease

The most current population-based series [from Sweden and Minnesota] have found that anoperineal involvement is seen in 14% to 38% of patients with Crohn’s disease, with isolated perianal disease seen in only 5%. The prevalence of perianal manifestations increases as the disease progresses distally, with only 15% of patients with ileocolic Crohn’s disease developing fistula but fistulae occurring in 92% of patients with Crohn’s disease involving the colon and rectum. There does not appear to be a predilection for age, with between 13% and 62% of children and adolescents with Crohn’s disease experiencing perianal manifestations; however, a younger age of onset increases the odds of developing perianal disease over time. Perianal Crohn’s disease is often recurrent, with 35% to 59% of patients relapsing within 2 years. More than 80% of patients require surgery, and as many as 31% require a permanent stoma. The presence of perianal disease is associated with a more disabling natural history, with increased extraintestinal manifestations and greater steroid resistance. Large studies have also shown an increased risk for squamous cell carcinoma and adenocarcinoma of the anus in patients with anorectal involvement.

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Last date updated on April, 2024