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Digestive Disorders

Crohn`s Perianal Fistula

09/02/2011

Question:

I have a 31-year history of Crohn`s disease with two small bowel resections in 1986 and 1996. I am not on any medications for it. In 2007 I developed a perianal fistula which has been confirmed as coming from the Crohn`s. The one opening is through the skin. I tried Remicade and it did not close it. I also had the setons removed. Then I gave up on it and stopped going to doctors until recently.

I found a new doctor and just had a pelvic MRI. He is still evaluating me to see what can be done for the fistula.

The results of the MRI were a 7-8mm wide right perianal fistula which is at least 10cm in length. It runs along side the vagina and extends to the anus inferiorly.

I was told before that the track is long but never had an exact measurement. My questions are...

Is 10cm long for a fistula of this type?

How significant is the length and the location for possibly closing it one day?

If I do nothing, what happens? Does it continue to lengthen and/or where can it go?

Thanks for your help in answering these questions.

Answer:

I am not exactly sure if 10 cm is long, but it sounds like it is quite significant. Remicade is the treatment of choice now for Crohn's fistulas but can sometimes take months to year to heal. Setons come in various lengths and is also an option but also a very long process. Doing nothing may result in worsening of fistula, more skin openings developing or infections which can be quite serious developing. Surgery may also be an option but only in hands of experienced surgeon.

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Response by:

Annette  Kyprianou, MD Annette Kyprianou, MD
Senior Clinical Instructor of Medicine
School of Medicine
Case Western Reserve University