Skip to main content
SpringerLink
Log in

Maladie de Crohn anopérinéale

Anoperineal Crohn’s disease

  • Mici
  • Published:
Acta Endoscopica

Conclusion

Les lésions ano-périnéales de la maladie de Crohn sont maintenant bien décrites sur le phan anatomoclinique mais aucune classification n’a été validée à ce jour et des lésions associées fortuitement à la maladie de Crohn sont parfois décrites à tort comme lésions anopérinéales de la maladie de Crohn (ce qui fausse les résultats thérapeutiques).

Par ailleurs, des incertitudes persistent sur leur génie évolutif propre, leurs réactions vis à vis des traitements où rien ne semble encore très bien codifié: le «savoir-faire» et l’expérience des équipes étant un gros atout thérapeutique.

On voit donc bien la nécessité de mettre en place des études multi-centriques (car les séries personnelles sont trop réduites) portant sur des lésions anopérinéales pouvant relever d’une classification interobservateurs fiable et sur lesquelles les traitements, médicaux ou chirurgicaux, pourraient être évalués sur des critères bien définis dans des séries randomisées.

Enfin, le retentissement évident de ces lésions sur la vie quotidienne des patients impose d’étendre les enquêtes de qualité de vie réalisés pour la maladie de Crohn iléocolique à la maladie de Crohn anopérinéale, ce qui permettra entre autres d’évaluer les traitements de façon plus fiable [83, 84]. France

Conlusion

Anoperineal lesions associated with Crohn’s disease are now well described in relation to their clinical anatomy, but no classification has been validated to this day and lesions associated with Crohn’s disease by chance are sometimes wrongly described as anoperineal Crohn’s disease lesions (that skewing therapeutic results).

In addition, incertitude persists regarding the way they may evolve on their own, their reactions after certain treatments where nothing seems to be very well classified at this point: the «know how» and experience of the teams have a large therapeutic influence.

One sees, therefore, the necessity to put in place multi-center studies (because the personal series are too small) on anoperineal lesions which can outline a reliable inter-observer staging with which treatments, medical or surgical, could be evaluated with well defined criteria in randomized series.

Finally, the obvious hold of these lesions on the daily life of patients requires to extend quality of life studies from ileocolonic Crohn’s disease to anoperineal Crohn’s disease, which will permit, among other things, to more effectively evaluate treatments [83, 84].

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. DALZIEL T.K. — Chronic interstitial enterities.Br. Med. J., 1913,2, 1068–1070.

    Google Scholar 

  2. GABRIEL W.B. — Results of an experimental and histological investigation into seventy-five cases of rectal fistulae.Proc. Royal Soc. Med., 1921,14, 156–161.

    CAS  Google Scholar 

  3. CROHN B.B., GINSBURG L., OPENHEIMER G.D. — Regional ileitis. A pathologic and clinical entity.Jama, 1932,99, 1323–1329.

    Google Scholar 

  4. BISSEL A.D. — Localized chronic ulcerative colitis.Ann. Surg., 1934,99, 957–966.

    Article  Google Scholar 

  5. PENNER A., CROHN B.B. — Perianal fistulae as a complication of regional ileitis.Ann. Surg., 1938,108, 867–873.

    Article  PubMed  CAS  Google Scholar 

  6. MORSON B.K., LOCKHART MUMMERY H.E. — Anal lesions in Crohn’s disease.Lancet, 1959,11, 1122–1123.

    Article  Google Scholar 

  7. GRAY B.K., LOCKHART-MMUMMERY H.E., MORSON B.C. — Crohn’s disease of the anal region.Gut, 1965,6, 515–524.

    Article  PubMed  CAS  Google Scholar 

  8. MARKOWITZ J., GRANCHER K., ROSA J. — Highly destructive perianal disease in children with Crohn’s disease.J. Ped. Gastrol Nutrition, 1995,21, 149–153.

    CAS  Google Scholar 

  9. PALDER S.B., SHANDING B., BILIK R. — Perianal complications of pediatric Crohn’s disease.J. Pediatr. Surg., 1991,26, 513–515.

    Article  PubMed  CAS  Google Scholar 

  10. BRANDT L.J., ESTRABOOK SG., REINUS J.F. — Result of survey to evaluate whether vaginal delivery and episiotomy lead to perineal involvement in women with Crohn’s disease.Am. J. Gastroenterol., 1995,90, 1918–1922.

    PubMed  CAS  Google Scholar 

  11. MARESCHAL C., VANHEUVERZWYN R., MELANGE M., FASSE R. — Chirurgie anale dans la maladie de Crohn. Résultats cliniques et fonctionnels.Gastroenterol. Clin. Biol., 1986,10, 204–207.

    PubMed  CAS  Google Scholar 

  12. WILLIAMS R., COLLER A., CORMAN M.L., NUGENT F.W., VEIDENHEIMER M.C. — Anal complications in Crohn’s disease.Dis. Colon Rectum, 1981,24, 22–24.

    Article  PubMed  CAS  Google Scholar 

  13. TAYLOR B.A., WILLIAMS G.T., HUGHES L.E., RHODES J. — The histology of anal skin tags in Crohn’s disease an aid to confirmation of the diagnosis.Int. J. Colorect. Dis., 1989,4, 197–199.

    Article  CAS  Google Scholar 

  14. SWEENEY J.L., RITCHIE J.K., NICHOLLS R.J. — Anal fissue in Crohn’s disease.Br. J. Surg., 1988,75, 56–57.

    Article  PubMed  CAS  Google Scholar 

  15. RADCLIFFE A.G., RITCHIE J.K., HAWLEY P.R., LENNARD-JONES J.E., NORTHOVER M.A — Anovaginal and rectovaginal fistulas in Crohn’s disease.Dis. Colon Rectum, 1988,31, 94–99.

    Article  PubMed  CAS  Google Scholar 

  16. HUSSAIN S.M., STOKER J., SCHOUTEN W.R., HOP W.C.J., LAMÉRIS J.S. — Fistula in ano: Endoanal sonography versus endoanal MR Imaging in classification.Radiology, 1996,200, 475–481.

    PubMed  CAS  Google Scholar 

  17. LINARES L., MOREIRA L.F., ANDREWS H., ALLAN R.N., ALEXANDER WILLIAMS J. and KEIGHLEY H.R.B. — Natural history and treatment of anorectal structure complicating Crohn’s disease.Br. J. Surg., 1988,75, 653–655.

    Article  PubMed  CAS  Google Scholar 

  18. BUCHMANN P., ALEXANDER-WILLIAMS J. — Classification of perianal Crohn’s disease.Clin. Gastroenterol., 1980,9 (2), 323–330.

    PubMed  CAS  Google Scholar 

  19. LOCKART-MUMMERY H.E. — Crohn’s disease.Anal Lesions. Dis. Colon Rectum, 1975,18, 200–202.

    Article  Google Scholar 

  20. HUGHES L.E. — Surgical pathology and management of anorectal Crohn’s diseaseJ. Roy. Soc. Med., 1978,71, 644–651.

    CAS  PubMed  Google Scholar 

  21. HUGHES L.E. — Clinical classification of perianal Crohn’s disease.Dis Colon Rectum, 1982,35, 928–932.

    Article  Google Scholar 

  22. ALLAN A., LINARES L., SPOONER H.A., ALEXANDER-WILLIAM J. — Clinical index to quantitate symptoms of perianal Crohn’s disease.Disease of colon and rectum, 1992,35, 656–661.

    Article  CAS  Google Scholar 

  23. IRVINE E.J. — Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index.Journal of clinic gastroenterology, 1995,20, 27–32.

    Article  CAS  Google Scholar 

  24. CHURCH J. M., FAZIO V.W., LAVERY I.C., OAKLEY J.R., MILSOM J.W. — The differential dignosis and commorbidity of hidradenitis suppurativa and perianal Crohn’s disease.Int J Colorec Dis, 1993,8, 117–119.

    Article  CAS  Google Scholar 

  25. BUCHMANN P., KEIGHLEY M.R.B., ALLAN R.N., THOMPSON H., ALEXANDER-WILLIAMS J. — Natural history of perianal Crohn’s disease. Ten year follow-up: a plea for conservatism.Am. J. Surg., 1980,140, 642–644.

    Article  PubMed  CAS  Google Scholar 

  26. KEIGHLEY M.R.B. and ALLAN R.N. — Current status and influence of operation on perianal Crohn’s disease.Int. J. Colorect. Dis., 1986, 104–107.

  27. VALLEUR P. — Maladie de Crohn périnéale: indications d’amputation du rectum.Bulletin français de Colo-proctologie, 1998,3, 10.

    Google Scholar 

  28. BALL C.S., WUJANTO R., HABOUBI N.Y., SCHOFIELD P.F. — Carcinoma in anal crohn’s disease. Discussion paper.J. Roy. Soc. Med., 1988,81, 217–219.

    CAS  PubMed  Google Scholar 

  29. MOODY G., PROBERT C.S., SRIVASTARA E.M., RHODES J., MAYBERRY J.F. — Sexual dysfunction amongst woman with Crohn’s disease.A hidden problem Digestion, 1992,52, 179–183.

    CAS  Google Scholar 

  30. HUGES L.E., DOUALDSON D.R., WILLIAMS J.C., TAYLOR B.A. — and Young H.L.. Local depot methylprednisolone. Injection for painful anal Crohn’s disease.Gastroenterology, 1988,94, 709–711.

    Google Scholar 

  31. PESCATORI M., INTERISANO A., BASSO L. — Management of perianal Crohn’s disease.Dis. Colon Rectum 1995,38, 121–124.

    Article  PubMed  CAS  Google Scholar 

  32. SIPROUDHIS L., MORTAJI A., MARY J.Y., JUGUET F., BRETAGNE J.F., GOSSELIN M. — Anal lesion: any significant prognosis in Crohn’s diesease?European Journal of Gastroenterology and Hepatology, 1997,9, 239–243.

    PubMed  CAS  Google Scholar 

  33. KORELITZ B.I., PRESENT D.H. — Favorable effect of 6 Mercaptopurine on fistulae of Crohn’s disease.Dig. Dis. Sci., 1985,30, 58–64.

    Article  PubMed  CAS  Google Scholar 

  34. MARKOWITZ J., ROSA J., GRANCHER K., AIGES H., DAUM F. — Long-term 6 Mercaptopurine treatment in adolescent with Crohn’s disease.Gastroenterology, 1990,99, 1347–1351.

    PubMed  CAS  Google Scholar 

  35. LEMANN M., BONHOMME P., BITOUN F., MESSING B., MODIGLIANI R., RAMBAUD J.C. — Traitement de la maladie de Crohn par l’azathioprine ou le 6-mercaptopurine. Etude rétropective chez 126 malades.Gastroenterol. Clin. Biol., 1990,14, 548–544.

    PubMed  CAS  Google Scholar 

  36. HANAUER S.B., SMITH M. — Rapid closure of Crohn’s disease fistulas with continous intravenous Cyclosporin A.Am. J. Gastroenterol., 1993,88, 646–649.

    PubMed  CAS  Google Scholar 

  37. PRESENT D.H., LIGHTIGER S. — Efficacity of Cyclosporine in treatement of fistulae of Crohn’s disease.Dig. Dis. Sci., 1994,39, 374–380.

    Article  PubMed  CAS  Google Scholar 

  38. BRYNSKOV J., FREUND L. — A placebo controlled double blind randomized trial of cyclosporine therapy in active chronic Crohn’s disease.N. Eng. J. Med., 1989,321, 845–850.

    CAS  Google Scholar 

  39. LEMANN M., CHAMIOT-PRIEUR C., MESNARD B., HALPEN M., MESSING B., RAMBAUD J.C. et coll. — Methotrexate for the treatement of refractory Crohn’s disease.Aliment. Pharmacol. Ther, 1996,10, 309–314.

    Article  PubMed  CAS  Google Scholar 

  40. FICKERT P., HINTERLEITNER B., AICHBICHLER B., WENZL H.H., PETRISCH W. — Mycophenolate mofetil in patients with Crohn’s disease.Gastroenterology, 1997,112, A972.

    Google Scholar 

  41. HORGAN K. — Initial experience with Mycophenolate mofetil in the treatment of severe inflammatory bowel disease.Gastroenterology, 1997,112, A999.

    Google Scholar 

  42. URSING E., KAMME C. — Métronidazole for Crohn disease.Lancet, 1975,i, 775–777.

    Article  Google Scholar 

  43. BRANDT L.J., BERNSTEIN L.H., BOLEY S.J., FRANK M.S. — Metronidazole therapy for perineal Crohn’s disease. A follow-up study.Gastroenterology, 1982,83, 383–387.

    PubMed  CAS  Google Scholar 

  44. BERNSTEIN L.H., FRANK M.S, BRANDT L.J., BOLEY. — Healing of perineal Crohn’s disease with metronidazole.Gastroenterology, 1980,79, 357–365.

    PubMed  CAS  Google Scholar 

  45. JACOBOVITS J., SCHUSTER M. — Metronidazole therapy for Crohn’s disease and associated fistulae.Am. J. Gastroenterol., 1984,30, 58–64.

    Google Scholar 

  46. MC KEE R.F., KEENAN R.A. — Perianal Crohn’s disease: Is it all bad news?Dis. Colon Rectum, 1996,39, 136–142.

    Article  CAS  Google Scholar 

  47. TURUNEN U., FARKKILA M. — Long-term outcome of Ciprofloxacin treatement in severe perianal.Gastroenterology, 1993,supp, A 793.

    Google Scholar 

  48. SOLOMON M.J., MC LEOD R.S., O’CONNOR B.I., STEINHART A.H., GREENBERG G.R., COHEN Z. — Combinasion ciprofloxacin and metronidazole in severe perineal crohn’s disease.Can. J. Gastroenterol, 1993,7, 571–572.

    Google Scholar 

  49. PINÈS A.E., GENDRE J.P., LE QUINTREC Y. — Le Lamprène dans les localisations anopérinéales de la maladie de Crohn.Ann. Gastroentérol. Hépatol., 1993,29, 155–163.

    Google Scholar 

  50. BRADY C.E., COOLEY B.J., DAVIS J.C. — Healing of severe Perineal and cutaneous Crohn’s disease with hyperbaric oxygen.Gastroenterology, 1989,97, 756–760.

    PubMed  Google Scholar 

  51. NELSON E.W., BRIGHT D.E. — Closure of refractory perineal Crohn’s lesion: Integration of Hyperbaric Oxygen into case management.Dig. Dis. Sci., 1990,35, 1561–1565.

    Article  PubMed  Google Scholar 

  52. HEIMBURGER D.C., TAMUSA T., MARKS R. D. — Rapid Improvement in dermatitis after zinc supplementation in a patient with a Crohn’s disease.The Am. J. of Med., 1990,88, 71–73.

    Article  CAS  Google Scholar 

  53. KRUIS W.K., RIDFLEISCH G.E., WEINZIERT M. — Zinc deficiency as a problem in patients with Crohn’s disease and fistula formation.Hepatogastroenterol, 1985, 32, 133–134.

    CAS  Google Scholar 

  54. VAN DEVENTER S.J.H., VON HOGEZAND R., PRESENT D. et coll. — Controlled study of anti-TNF a treatment for enterocutaneous fistulae complicating Crohn’s disease.Gut, 1997,41, 1–11.

    Article  Google Scholar 

  55. VAN DULLEMEN H.M., DE JONG E., SLORS F. et coll. — Treatment of therapy-resistant perineal metastatic Crohn’s disease after proctectomy using anti-tumor necrosis factor chimeric monoclonal antibodies cA2.Dis. Colon Rectum, 1998,41, 98–102.

    Article  PubMed  Google Scholar 

  56. WOLKOMIR A.F., LUCHTEFELD M.A. — Surgery for symptomatic hemmorroids and anal fissures in Crohn’s disease.Dis. Colon Rectum, 1993,36, 545–547.

    Article  PubMed  CAS  Google Scholar 

  57. FLESHNER P., SCHOETZ D. — Anal fissure in Crohn’s disease: a plea for agressive management.Dis Colon Rectum 1995, 38, 1137–1143.

    Article  PubMed  CAS  Google Scholar 

  58. MARKS C.G., RICHIE J.K., LOCKHART MUMMERY H.E. — Anal fistulas in Crohn’s disease.Br. J. Surg., 1981,68, 525–527.

    Article  PubMed  CAS  Google Scholar 

  59. HOBBIS J.H., SCHOFFIELD P.E. — Management of perianal Crohn’s disease.J. Roy. Soc. Med., 1982,75, 414.

    Google Scholar 

  60. FUHRMAN G., LARACH S. — Experience with perirectal Fistulas in patients with Crohn’s disease.Dis. Colon Rectum, 1989,32, 847–848.

    Article  PubMed  CAS  Google Scholar 

  61. LEVIEN D.H., SURRELL J., MAZIER P. — Surgical treatment of anorectal fistula in patients with Crohn’s disease.Surg. Gynecol. Obstet., 1989,169, 133–136.

    PubMed  CAS  Google Scholar 

  62. HALME L., SAINIO A.P. — Factor related to frequency, type, and outcome of anal fistula in Crohn’s disease.Dis. Colon Rectum, 1995,38, 55–59.

    Article  PubMed  CAS  Google Scholar 

  63. FAUCHERON J.L., SAINT-MARC O., GUIBERT L., PARC R. — Long-term seton drainage for high anal fistulas in Crohn’s disease: A sphincter-saving operation?Dis. Colon Rectum, 1996,39, 208–211.

    Article  PubMed  CAS  Google Scholar 

  64. WILLIAMS J.G., MAC LEOD C.A., ROTHENBERGER D.A., GOLDBERG S.M. — Seton treatment of high anal fistulae.Br. J. Surg., 1991,78, 1159–1161.

    Article  PubMed  CAS  Google Scholar 

  65. FRY R., SHEMESH E.I., KODNER I.J., TIMMCKE A. — Techniques and results in the management of anal and Perianal Crohn’s disease.Surg. Gynecol. Obst., 1989, 108, 42–48.

    Google Scholar 

  66. LEWIS P., BARTOLO D.C.C. — Treatment of trans-sphincteric fistulae by full thickness anorectal advancement flaps.Br. J. Surg., 1990,77, 1187–1189.

    Article  PubMed  CAS  Google Scholar 

  67. MAKOWIEC F., JEHLE E.C., BECKER H.D., STARLINGER M. — Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn’s disease.Br. J. Surg., 1995,82, 603–606.

    Article  PubMed  CAS  Google Scholar 

  68. GALLOT D., MALAFOSSE M., CONTOU J.F., MAUREL J., BENOIT J. — Le traitement chirurgical local des lésions anopérinéales de la maladie de Crohn: Etude rétrospective de 68 observations.Ann. Gastroenterol. Hepatol., 1991,27, 243–248.

    CAS  Google Scholar 

  69. FAULCONER H.T., MULDOON J.P. — Rectovaginal fistula in patients with colitis: review and report of a case.Dis. Colon Rectum, 1975, July–Aug, 413–415.

    Article  Google Scholar 

  70. TUXEN P.A., ALEJANDRU F.C. — Rectovaginal fistula in Crohn’s disease.Dis. Colon Rectum, 1979, Jan–Feb., 58–62.

    Article  Google Scholar 

  71. HULL T.L., FAZIO V.W. — Surgical approaches to low anovaginal fistula in Crohn’s disease.Am. J. Surg., 1997,173, 95–98.

    Article  PubMed  CAS  Google Scholar 

  72. HESTERBERG R., SCHMIDT W.U., MULLER F., ROCHER H.D. — Treatement of anovaginal fistulas with an anocutaneous flap in patients with Crohn’s disease.Int. Colorect. Dis., 1993,8, 51–54.

    Article  CAS  Google Scholar 

  73. SHER M.E., BAUER J.J., GELERNT J. — Surgical repair of rectovaginal fistulas in patient with Crohn’s disease: Transvaginal approach.Dis. Colon Rectum, 1991,34, 641–648.

    Article  PubMed  CAS  Google Scholar 

  74. WINSKIND A.K., THOMPSON J.D. — Transverse transperinal repair of rectovaginal fistulas in the lower vagina.Am. J. Obstet. Gynecol., 1992,167, 694–699.

    Google Scholar 

  75. FAZIO V.W., JONES I.J., JAGELMAN D.G., WEAKLEY F.L. — Rectourethral fistulas in Crohn’s disease.Surg., Gynecol. Obstet., 1987,164, 148–150.

    CAS  Google Scholar 

  76. BURMANN J.H., THOMPSON H., COOKE W.T., ALEXANDER-WILLIAM J. — The effects of diversion of intestinal contents of the passage of Crohn’s disease of the large bowel.Gut, 1971,12, 11–15.

    Article  Google Scholar 

  77. WILLIAMSON M.E.R., HUGUES L.E — Bowel diversion should be used with caution in stenosing anal Crohn’s disease.Gut, 1994,35, 1139–1140.

    Article  PubMed  CAS  Google Scholar 

  78. BERNARD D., MORGAN S., TASSÉ D. — Selective Surgical Management of Crohn’s disease of the anus.Can. J. Surg., 1986,29, 318–321.

    PubMed  CAS  Google Scholar 

  79. FRANÇOIS Y., GRIOT J.B., GILLY F.N., CARRY P.Y., SAYAG A., DESCOS L. et coll. — Réparations sphinctériennes dans la maladie de Crohn.Lyon Chir., 1995,91, 365–367.

    Google Scholar 

  80. GRANT D.R., COHEN Z., MCLEOD R.S. — Loop ileostomy for anorectal Crohn’s disease.Can. J. Surg., 1986,29, 32–35.

    PubMed  CAS  Google Scholar 

  81. HARPER P.H., KETTLEWELL M.G.W., LEE E.C.G. — The effect of spilit ileostomy on perianal Crohn’s disease.Br. J. Surg., 1982, 69, 608–610.

    Article  PubMed  CAS  Google Scholar 

  82. GIVEL J.C., HAWKER P., ALLAN R.N., ALEXANDER-WILLIAMS J. — Enterovaginal fistulas associated with Crohn’s disease.Surg. Gynecol. Obstet., 1982,155, 494–496.

    PubMed  CAS  Google Scholar 

  83. COLOMBEL JF., YASDANPANAH Y., LAURENT F., HOUCKE P., DELAS N., MARQUIS P. — Qualité de vie dans les maladies inflammatoires chroniques de l’intestin.Gastroenterol. Clin. Biol., 1996,20, 1071–1077.

    PubMed  CAS  Google Scholar 

  84. DOUGLASS A., DROSSMAN, DONALD L. — Healthrelated quality of life in inflammatory bowel disease.Dig. Dis. Sci., 1989,34, 1379–1386.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hôpital Léopold Bellan-Service de colo-proctologie et de gastro-entérologie, 19-21, rue Vercingétorix, 75674, Paris Cedex 14

    D. Bouchard & J. Denis

Authors
  1. D. Bouchard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Denis
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Bouchard, D., Denis, J. Maladie de Crohn anopérinéale. Acta Endosc 29, 283–301 (1999). https://doi.org/10.1007/BF03019417

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03019417

Mots-clés

Key-words

Search

Navigation