EP664 - Nowhere but Below: The Unpredictable Course of Isolated Perianal Crohn’s Disease

ePoster Presenter(s)

• 

  Andrew Hu, MD

  General Surgery Resident
  UMass Chan Medical School
  University of Massachusetts T.H Chan Medical School
  Worcester, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Benjamin Gallant, MD

  General Surgery Resident
  UMass Chan Medical School
  UMass Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.
• AL

  Anqi Liu, MD

  General Surgery Resident
  UMass Chan Medical School
  Shrewsbury, Massachusetts, United States

  Disclosure information not submitted.
• MR

  Milan Rosen, n/a

  Medical Student
  UMass Chan Medical School
  Worcester, Massachusetts, United States

  Disclosure information not submitted.
• 

  Karim Alavi, MD, MPH

  Associate Professor of Surgery, Director, Colon and Rectal Surgery Fellowship
  UMass Chan Medical School
  southborough, Massachusetts, United States

  Disclosure information not submitted.
• 

  Justin Maykel, MD

  Chief, Division of Colorectal Surgery
  UMass Memorial Health
  UMass Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.
• TP

  Thomas Peponis, MD, FACS

  Colon and Rectal Surgeon, Assistant Professor of Surgery
  University of Massachusetts
  Worcester, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• PS

  Paul R. Sturrock, MD

  Assistant Professor of Surgery
  UMassMemorial Medical Center
  Worcester, Massachusetts, United States

  Disclosure information not submitted.
• AR

  Abbas Rupawala, MD

  Gastroenterologist
  UMass Memorial Medical Center
  Worcester, Massachusetts, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Tess H. Aulet, MD (she/her/hers)

  Colorectal Surgeon
  UMass Memorial Medical Center
  UMass Memorial Medical Center
  Worcester, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Purpose/Background: Perianal Crohn's disease (pCD) is a complex problem that frequently requires multidisciplinary management. Infliximab and adalimumab are currently the only FDA-approved medications for pCD, but many patients ultimately require surgical intervention. While up to 45% of patients with Crohn's disease develop perianal manifestations, the natural history and outcomes of patients with isolated pCD remain poorly characterized. We aimed to investigate the treatment patterns and clinical course of patients with pCD.

Methods/Interventions: This is a retrospective chart review at a single tertiary academic medical center between January 1, 2018, and January 1, 2025. We included adult patients with perianal Crohn's disease. We excluded patients with known intestinal disease. Demographic data, clinical features, treatment approaches, and outcomes were abstracted into a REDCap database. The primary aim of the study was to describe the patient demographics, treatment patterns, and clinical course. Continuous data are presented as medians with interquartile ranges, and categorical data are presented as frequencies.

Results/Outcomes: Of 350 patients screened with Crohn's disease and perianal symptoms, a total of 22 had isolated perianal manifestations and were included in the study. The mean age was 41.4 years (SD 15.9) with a bimodal distribution. The majority were white (91%) and non-Hispanic (100%), with 23% reporting current smoking. The median number of operative interventions for perianal complaints was two (IQR 1-3), with the most common being fistulotomy. The median number of seton placements was 1 (IQR 1-3), with a median duration of seton placement of 12 months (IQR 6.8-36). During follow-up, 13 patients (59%) progressed to luminal Crohn's disease, while 9 (41%) remained isolated to the perianal region. Overall, 68.2% of patients had failed at least one prior medical therapy, most commonly infliximab or adalimumab (36.4% each). Infliximab and adalimumab were also the most frequent ongoing treatments at the time of data collection.

Conclusion/Discussion: This study represents one of the largest single-institution series of isolated pCD to date. Despite the absence of luminal involvement at presentation, the majority of patients ultimately required repeated operative interventions, and more than half progressed to luminal disease. These findings highlight the heterogeneity of disease courses and the ongoing need for standardized management strategies for isolated pCD as the disease evolves over time.

Table 1: Demographics
Table 2: Outcomes of Isolated Perianal Crohn's Patients