Abdominoperineal Resection for Intractable Anorectal Crohn's Disease

Kazutaka Koganei, Hideaki Kimura¹⁾, Akira Sugita¹⁾, Katsuhiko Arai¹⁾, Tsuneo Fukushima¹⁾ and Hiroshi Shimada²⁾

Chronic Intractable Disease Center, Yokohama City University Medical Center Department of Surgery, Yokohama Citizen's Municipal Hospital¹⁾
Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine²⁾

Introduction: Indications and efficacy of abdominoperineal resection in patients with intractable anorectal Crohn's disease remain unclear. Materials and methods: We studied indications, effects, and complications in 12 patients-8 men and 4 women-undergoing abdominoperineal resection for intractable anorectal Crohn's disease. Results: Of the 12, 83% had both complex perianal fistula and anal or rectal stenosis, and 8 of these also had complications of fistula from rectum or perirectal abscess or ano- or rectovaginal fistula. One patient had a large perianal fistula originating in the rectum with fibrous change. Another had a perirectal abscess and a fistula from the rectum. All resected rectum showed fibrous change and deep ulcers were the primary lesion in 7 of 12 specimens. After abdominoperineal resection, symptoms such as severe perianal pain, pyrexia, vaginal discharge, and disability on urination improved in all 12 (100%). Purulent discharge from fistulas improved in 6 of 7 (86%). Following these improvements, 9 of the 12 (75%) went back to work, although 5 (42%) had 6 complications involving delayed perineal wound healing or pelvic abscess. Conclusions: Abdominoperineal resection relieves symptoms of intractable anorectal Crohn's disease, improving occupational and social functioning in most patients. Anal or rectal stenosis with fistulous complications does not improve with conservative therapy, so abdominoperineal resection should be considered in patients with these complications.

Key words
Crohn's disease, anorectal complications, abdominoperineal resection

Reprint requests
Kazutaka Koganei Chronic Intractable Disease Center, Yokohama City University Medical Center
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
October 19, 2005

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