대한대장항문학회

Crypt glandular infection theory is accepted as an explanation of anal fistula's major<br>cause. However, the pathogenesis of an anal fistula in Crohn's disease is different from<br>that of a conventional anal fistula because a Crohn's anal fistula is caused by ulceration<br>which, in turn, is caused by transmural inflammation of the rectal wall due to Crohn's<br>disease. The difficulty with operating on anal fistulas in Crohn's disease lies in the fact<br>that healing of the wound is inhibited because of continuous inflammation of the<br>anorectal tissue due to Crohn's disease. Hence, there is a high possibility of incontinence<br>due to sphincter muscle injury. Especially, because almost all Crohn's disease patients<br>have frequent defecation and diarrhea, the patients will suffer more if<br>incontinence<br>occurs. Nowadays, even with increased understanding of the etiology of Crohn's disease,<br>new medications, and aggressive surgical approaches, the result of treatment is still not<br>satisfactory. Recently, since Korean eating habits have changed to include more<br>western-style food in the diet, inflammatory bowel disease, such as Crohn's disease, is<br>expected to increase. Consequently, the number of cases of anal fistulas in Crohn's<br>disease is also expected to increase.<br>The authors reviewed 20 confirmed cases of anal fistulas in Crohn's disease, which<br>were treated from January 1993 to December 1995 at Song-Do Colorectal Hospital. The<br>results are as follows:<br>1) Anal fistulas in Crohn's disease were present in 20(0.6%) of the 3378 cases of anal<br>fistulas treated during the time period considered.<br>2) The male to female ratio for these 20 cases was 2: 1, and the most Prevalent age<br>group was the 3rd decade, followed by the 2nd decade, the 4th decade, and the 5th<br>decade in that order.<br>3) Three cases of anal fistulas whose origins could be explained by crypt glandular<br>infection theory and which did not involve the rectum healed, although the healing was<br>delayed.<br>4) Seventeen cases of anal fistulas whose origins could not be explained by crypt<br>glandular infection theory and which involved the rectum did not heal after the<br>operation.<br>The results of the study show that anal fistulas whose origins can be explanined by<br>crypt glandular infection theory and which do not involve the rectum can be cured by<br>conventional fistula surgery. However, perirectal fistulas whose origins can not be<br>explained by crypt glandular infection theory and which involve the rectum do not heal.<br>Because there is the possibility of incontinence after a conventional operation, it is<br>suggested that, in the cases of perirectal fistulas in Crohn's disease, better results,<br>although not completely satisfactory, can be obtained by long-term seton drainage and<br>diversion colostomy.<br>