Perianal Crohn's Disease

A 56-year-old man complained of perianal swelling and discomfort. He reported a history of diarrhea and mucus discharge from the rectum with intermittent rectal bleeding. A colonoscopy confirmed the diagnosis of Crohn's disease of the rectum and sigmoid colon.

As seen in the Figure, with the patient in a left lateral decubitus position, a fleshy, swollen perianal tag was noted. A small ulceration located anteriorly at the anal verge can also be seen. Dr Virenda Parikh of Fort Wayne, Ind, notes that this lesion was painless on digital examination.

Perianal Crohn's disease occurs in 10% to 80% of patients with Crohn's disease; it is the first manifestation of Crohn's disease in approximately 3% of patients.¹ Lesions associated with anorectal Crohn's disease include abscesses, fistulae, and deep anal fissures. Often these are multiple and may be relatively painless.

Anal tags also are seen in this disease. Typically, they are large, edematous, engorged, and bluish. These tags frequently cause pain on sitting and make the anal region difficult to clean. Aggressive use of a topical corticosteroid cream, sitz baths, and control of rectal mucosal disease with anti-inflammatory agents and corticosteroid enemas are helpful in relieving symptoms. This patient recovered well after topical corticosteroid cream and sitz baths were used. Corticosteroid enemas were also prescribed for inflamed rectal mucosa.

REFERENCE:1. Caroline DF, Friedman AC. The radiology of inflammatory bowel disease. Med Clin North Am. 1994;78:1353-1385.