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Perianal Disease in Crohn Disease
Anorectal Crohn disease may consist of fissures, ulcers, abscesses, fistulae, strictures, edematous skin tags, and benign skin tags ( Fig. 96.1 ). The overall prevalence is 36%, but it is 46% when the colon is involved and only 25% when the small bowel is involved. Often, one of these lesions may appear before there is evidence of intestinal disease.
Crohn Disease: Perianal Disease.
Clinical Picture
The patient may have only mild diarrhea or may have severe rectal pain or bulging abscesses. A simple skin tag may be enlarged and painless but can be rectally disfiguring (“elephant ears”). Such pain is severe and necessitates emergency treatment.
Physical examination on the exterior can reveal the lesion. It is important to test for local tenderness and look for discharge from a fistula. At times, it may be too difficult to perform a rectal examination, but the anal ring can be teased, and often a small fissure can be demonstrated without entering the anal ring. Bulging of a large abscess is obvious.
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