Medical and surgical management of perianal Crohn's disease

Gabriel (1) described multinucleated giant cells in the tissues of patients with rectal fistulae ˜10 years before the classic description of Crohn's disease by Crohn et al. (2). However, the association of perianal disease with Crohn's disease was not recognized initially. Subsequently, it was recognized that perianal lesions may precede the intestinal manifestations by many years (3). Although the significance of perianal lesions was not appreciated initially, their significance is now well recognized, partly because of their frequency and partly because of their morbidity. Thus, management of perianal disease is often an important component of the overall management of the Crohn's patient. There is great variation in the reported frequency of perianal lesions. These discrepancies are likely due to differences in the intensity of the search made for anal lesions and in the definitions of what constitutes perianal Crohn's disease. In addition, most reviews have been performed retrospectively.