Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India.
Department of Radiology and Radiodiagnosis, Dayanand Medical College, Ludhiana, 141 001, India.
Indian J Gastroenterol. 2023 Oct;42(5):668-676. doi: 10.1007/s12664-023-01399-9. Epub 2023 Aug 7.
Fistulizing perianal Crohn's disease (CD) is a debilitating condition associated with significant morbidity and reduction in the quality of life. Magnetic resonance imaging (MRI) of the pelvis is the preferred imaging modality for the comprehensive assessment of the perianal fistula. There is a paucity of data from India on the MRI spectrum of complex perianal fistula in CD.
A single-centre cross-sectional analysis of patients with fistulizing perianal CD, who underwent pelvic MRI between January 2020 and December 2021, was performed. The clinical (age, sex, disease duration, disease location and behavior, disease activity [Perianal Disease Activity Index, PDAI] and treatment received) and radiological (number and location of fistulae, extensions, number and location of internal and external openings, fistula activity, presence or absence of perianal abscess and associated proctitis) characteristics of complex perianal fistula (defined according to the American Gastroenterological Association classification) were recorded.
Of total 175 patients with CD who attended the gastroenterology clinic during the study period, 27 (15.42%) (mean age 42±15.5 years, 62.96% females and median disease duration four years) had complex perianal fistula and were included in the analysis. The mean PDAI was 5.48±2.53. The median Van Assche Index was 17 (interquartile range [IQR] 13-19). A majority (96.29%) of the fistulae were trans-sphincteric and four (14.81%) fistulae extended into the supralevator space. All fistulae were active on MRI. Concomitant perianal abscess and proctitis were seen in 59.26% (n=16) and 62.96% (n=17) of patients, respectively. Combination therapy with biologics and antibiotics/immune-suppressants were the most commonly prescribed medical therapy. Six (22.22%) patients underwent combined medical and surgical (non-cutting seton, fistulectomy, fecal diversion) treatment.
The cumulative risk of the development of fistulizing perianal CD in a northern Indian cohort was similar to the western populations. Complex perianal fistulae were predominantly trans-sphincteric and commoner in females. MRI evaluation is pivotal for the delineation of fistula anatomy, assessment of disease extent and activity and the evaluation of concomitant perianal abscess and other complications.
瘘管性肛周克罗恩病（CD）是一种使人虚弱的疾病，与显著的发病率和生活质量下降有关。盆腔磁共振成像（MRI）是评估肛周瘘管的首选影像学方法。来自印度的关于 CD 复杂肛周瘘管的 MRI 谱的数据很少。
对 2020 年 1 月至 2021 年 12 月期间在我院行盆腔 MRI 的瘘管性肛周 CD 患者进行单中心横断面分析。记录临床（年龄、性别、疾病持续时间、疾病部位和行为、疾病活动度[肛周疾病活动指数，PDAI]和接受的治疗）和影像学（瘘管数量和位置、延伸、内口和外口数量和位置、瘘管活动度、肛周脓肿和相关直肠炎的存在或不存在）特征复杂肛周瘘管（根据美国胃肠病学会分类定义）。
在研究期间，在胃肠病门诊就诊的 175 例 CD 患者中，有 27 例（15.42%）（平均年龄 42±15.5 岁，62.96%为女性，中位疾病持续时间为 4 年）患有复杂肛周瘘管并纳入分析。平均 PDAI 为 5.48±2.53。中位数 Van Assche 指数为 17（四分位距 [IQR] 13-19）。大多数（96.29%）瘘管为经括约肌瘘，4 个（14.81%）瘘管延伸至超括约肌间隙。所有瘘管在 MRI 上均为活动期。59.26%（n=16）和 62.96%（n=17）的患者分别存在肛周脓肿和直肠炎。生物制剂和抗生素/免疫抑制剂联合治疗是最常用的药物治疗。6 例（22.22%）患者接受了联合药物和手术（非切割挂线、瘘管切除术、粪便分流）治疗。
在印度北部队列中，发生瘘管性肛周 CD 的累积风险与西方人群相似。复杂肛周瘘管主要为经括约肌瘘，女性更常见。MRI 评估对于瘘管解剖的描绘、疾病程度和活动的评估以及肛周脓肿和其他并发症的评估至关重要。
