Child Life and Health, University of Edinburgh.
Department of Paediatric Gastroenterology and Nutrition.
J Pediatr Gastroenterol Nutr. 2022 Jan 1;74(1):68-71. doi: 10.1097/MPG.0000000000003285.
Fissuring perianal Crohn disease (CD) is not recognised as a perianal phenotype in Montreal/Paris inflammatory bowel disease classifications; however, can occasionally present as complicated disease with severe perianal pain driving increasingly intensive medical therapy despite well controlled luminal disease. We identified a regional cohort of prospectively acquired incident cases of paediatric CD diagnosed <16 years of age in South-East Scotland over a 19-year period (1999-2018), and conducted a retrospective review of complicated fissuring perianal CD causing severe pain related to anal sphincter complex spasm at defecation. Two hundred forty-seven new cases of paediatric CD were diagnosed with complicated fissuring perianal disease identified in 4 described cases (cumulative incidence 1.6%). These patients with marked fissuring and refractory anal sphincter complex spasm required neurostimulation-guided, 4-quadrant, anal intrasphincteric botulinum toxin (BT). All experienced immediate success, measured by cessation of spasms, with variable ongoing symptom relief after median (range) 3 (2-5) BT injections.
肛门周围克罗恩病（CD）的裂沟并不被认为是蒙特利尔/巴黎炎症性肠病分类中的一种肛门周围表型；然而，它偶尔会表现为复杂疾病，尽管肠道疾病得到了很好的控制，但严重的肛门周围疼痛导致需要不断加强药物治疗。我们在苏格兰东南部，对 19 年期间（1999-2018 年）诊断出的年龄<16 岁的儿童 CD 前瞻性获取的发病病例进行了区域性队列研究，并对导致排便时肛门括约肌复合体痉挛的严重疼痛的复杂肛裂性 CD 进行了回顾性分析。在 4 例描述性病例中发现了 4 例儿童 CD 伴复杂肛裂性疾病（累积发病率为 1.6%）。这些有明显裂沟和难治性肛门括约肌复合体痉挛的患者需要神经刺激引导的 4 象限肛门内括约肌肉毒毒素（BT）治疗。所有患者在接受 BT 注射后，痉挛立即停止，中位数（范围）3（2-5）次后，痉挛持续缓解，立即获得成功。
