2 min read - Crohn's disease


A 21 years old boy presented with a painful perianal lump. He had taken treatment 4 times from a another doctor during the last two years for similar symptoms.


He made an incision and drained the abscess under local anaesthesia. Started the patient on oral coamoxyclav and sent him home.

If you were the doctor, what would you have done?

In any patient presenting with recurrent perianal disease including abscesses and fistulae, you have to suspect Crohn's disease.

 Is it common?

 It certainly is, but only if you are vigilant enough to suspect it and diagnose.

 Why should you bother, if it's a fistula or abscess you can just drain it or do a surgical intervention, isn't it?

 NO! Perianal involvement in crohn's disease is nasty. It can badly affect the patients quality of life. Imagine having to live the rest of life with discharging wounds in the perineum. 

 How can you make the diagnosis of crohn's disease?

 A good history and examination will help you make the diagnosis. Oral ulcers, features of malabsorption including weight loss and nutritional deficiencies and extra-articular manifestations should be looked for. Endoscopy and biopsy is necessary to confirm the diagnosis. However, TB remains an important differential diagnosis which is difficult to exclude.

 So, best thing is to refer the patient to a gastroenterologist / surgeon if the diagnosis of crohn's is suspected.

 What are the treatment options for perianal crohns disease?

 There are two major aspects. Management of the infection with proper antibiotics and necessary surgical interventions should be done first.

 To achieve disease remission in crohn's disease with perianal disease the recommended first line treatment is BIOLOGIC agents!

 Really?

 Yes!

 Is it the practice in Sri Lanka as well?

 Yes!

 Well, then it must be really hard to treat!

 Yes! Therefore, never miss the diagnosis!

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