الفهرس 
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Abstract
Crohn’s disease is a chronic inflammatory disorder of uncertain etiology that can arise in persons of any age and involve all segments of the alimentary tract plus extraintestinal sites.
Crohn’s disease is marked by one of three major patterns: disease in the ileum and cecum (40% of patients), disease confined to the small intestine (30%), and disease confined to the colon (25%). Much less commonly, Crohn’s disease involves more proximal parts of the gastrointestinal tract—the mouth, tongue, esophagus, stomach, and duodenum.
Perianal manifestations may occur, including perianal skin lesions (anal skin tags, hemorrhoids), anal canal lesions (anal fissures, anal ulcers, anorectal strictures), perianal fistulas and abscesses, rectovaginal fistulas, and cancer.
Perianal fistulas are common manifestations of Crohn’s disease that can lead to significant morbidity and even proctectomy. As it is generally assumed that Crohn’s disease is a heterogeneous disease that is composed of subsets of disorders representing different pathogenic mechanisms, numerous genotype– phenotype.
Endo-anal ultrasound evaluation of periano-rectal fistulae and abscesses in Crohn’s disease has proven to be superior to fistulography and Computed Tomography, and equivalent or superior to Magnetic resonance imaging. Endo-anal ultrasound, Magnetic resonance imaging and examination under anesthesia, may be complementary to one another with the most optimal approach being a combination of these modalities.
Fistulizing Crohn’s disease may lead to significant physical and psychosocial complications. Even with the best available services for this condition, the chance of complete healing by clinical assessment is not more than 50%.
The management of patients with Crohn’s perianal fistulas continues to be challenging. Despite this recent advance, the primary goals of management of perianal Crohn’s disease remain unchanged; relief of symptoms, control of sepsis and preservation of an intact anal sphincter. Medical therapy has demonstrated limited efficacy with relapse after cessation of treatment. Operative treatment has shown good results but puts the patient at an increased risk for fecal incontinence.
The introduction of the tumour necrosis factor alpha (TNFa) antagonist infliximab, with a reported beneficial response rate of 66% to 78%, has led many clinicians to re-evaluate the management of this difficult condition and, in particular, the role of surgery.
The objective of the retrospective study reported here was to describe the clinical course of perianal Crohn’s disease. We determined the time course of inactivation of perianal manifestations as fistulas and associated abscesses, the probabilities of healing and recurrent fistula activity. Faecal diversion, rectal disease, the type of fistula, and medical treatment were evaluated as prognostic indicators of healing and symptomatic recurrence of perianal manifestations of Crohn’s disease.