Lin Yi Fan, Truchon Alicia, Djoukam Mbuko Boris, Dai Huan Yu Lily, Sassine Samuel, Damphousse Amélie, Benali Sébastien, Beaunoyer Mona, Deslandres Colette, Jantchou Prévost
CHU Sainte-Justine Research Center, Montreal, QC, Canada.
Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
Inflamm Bowel Dis. 2026 Feb 1;32(2):237-244. doi: 10.1093/ibd/izaf220.
Perianal manifestations are common at diagnosis of Crohn's Disease and include perianal fistulas, abscesses, fissures, and inflammatory anal skin tags. Perianal fistulizing Crohn's disease (PFCD), involving fistulas and abscesses, is associated with a poor prognosis in children.This study aimed to identify the factors associated with PFCD at diagnosis. Secondary aims were to: assess factors associated with the severity of PFCD according to the Van Assche score, characterize the prevalence of perianal Crohn's disease in a Canadian cohort, and evaluate its management at diagnosis.
We collected data from patients aged 4-18 years diagnosed with Crohn's disease between 2009 and 2021 at our IBD center who underwent perineal magnetic resonance imaging within three months of diagnosis. Perianal Crohn's disease was assessed clinically and through MRI results.
Among 489 patients (57.9% male, median age 13.8 years), 229 (46.8%) had perianal Crohn's disease. Perianal fistulizing Crohn's disease was identified in 115 patients (23.5%), including 13.0% without any clinical signs. The median Van Assche score was 13.0 in patients with PFCD versus 2.0 in those without. Male sex, granulomas on intestinal biopsies, and anal fissures were associated with both the presence and increased severity of PFCD.
This study emphasizes the importance of performing perianal MRI early at the diagnosis as occult perianal fistulizing Crohn's disease may be discovered. Male sex, granulomas on intestinal biopsies and anal fissures were associated both with the presence of PFCD and increased severity.
肛周表现是克罗恩病诊断时的常见症状，包括肛周瘘管、脓肿、肛裂和炎性肛门皮赘。涉及瘘管和脓肿的肛周瘘管性克罗恩病（PFCD）在儿童中预后较差。本研究旨在确定诊断时与PFCD相关的因素。次要目的是：根据范阿舍评分评估与PFCD严重程度相关的因素，描述加拿大队列中肛周克罗恩病的患病率，并评估其诊断时的治疗情况。
我们收集了2009年至2021年期间在我们的炎症性肠病中心诊断为克罗恩病的4至18岁患者的数据，这些患者在诊断后三个月内接受了会阴磁共振成像检查。通过临床检查和MRI结果评估肛周克罗恩病。
在489例患者（男性占57.9%，中位年龄13.8岁）中，229例（46.8%）患有肛周克罗恩病。115例患者（23.5%）被确诊为肛周瘘管性克罗恩病，其中13.0%没有任何临床症状。PFCD患者的范阿舍评分中位数为13.0，而无PFCD患者为2.0。男性、肠道活检发现肉芽肿和肛裂与PFCD的存在及严重程度增加均相关。
本研究强调了在诊断时早期进行肛周MRI检查的重要性，因为可能会发现隐匿性肛周瘘管性克罗恩病。男性、肠道活检发现肉芽肿和肛裂与PFCD的存在及严重程度增加均相关。
