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Colorectal Diseases

Perianal fistula

09/23/2009

Question:

I have a perianal fistula due to a 28-year history of Crohn`s Disease and the fistula has "a long track." The disease itself is very calm and has been for a few years.

For one year now, I have left the perianal fistula untreated and had the three setons removed after a failed plug procedure and after three courses of Remicade failed. I do not see any doctors at all. The fistula continues to drain pus and blood on its own. It is sore and red sometimes but Motrin and baby powder gets me through that.

What could happen down the road if I continue to leave it untreated as long as it does not seal up and form another abscess? I assume since it hasn`t sealed up in over a year, my odds for another abscess are low. The doctors all say they cannot close it with surgery anyway and the only answer is setons, which I do not want. The setons are just meant to keep it open which it is on its own anyway.

So is it fine to continue to leave it untreated?

Thanks.

Answer:

Yes, if it is not painful or too bothersome, and the Crohn's inflammation precludes healing, there is no need to continue to pursue surgical repair. The chronic inflammation in a Crohn's fistula can, occasionally, degenerate into a malignancy, so it is a good idea to have someone keep an eye on it for you on a periodic (perhaps every 6-12 month) basis.

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Response by:

Janice Frederick Rafferty, MD Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati