BACKGROUND: 

Anorectal stricturing is a particularly morbid manifestation of Crohn’s disease resulting in a diminished quality of life related to pain, incontinence, and recurrent operative interventions.

OBJECTIVE: 

To determine the role of medical therapy, endoscopic dilation, and surgical intervention for the treatment of isolated anorectal stricturing.

DATA SOURCES: 

An organized search of MEDLINE, PubMed, EMBASE, Scopus, and the Cochrane Database of Collected Reviews was performed from January 1, 1990 through May 1, 2020.

STUDY SELECTION: 

Full text papers which included management of isolated anorectal strictures in the setting of Crohn’s disease.

INTERVENTION(S): 

Medical and surgical management.

MAIN OUTCOME MEASURES: 

Symptomatic relief, need for proctocolectomy.

RESULTS: 

Our search identified a total of 553 papers; after exclusion based on title (n = 430) and abstract (n = 47), 76 underwent full text review with 65 relevant to the management of anorectal strictures. A summary of the retrospective reports suggests that medical therapy can help control luminal inflammation, but fibrosis may ultimately set in resulting in a need for endoscopic or surgical intervention. Surgical options are limited in the anal canal due to inflammation and ulceration and concomitant perianal fistulizing disease. While fecal diversion can provide symptomatic relief, successful restoration of intestinal continuity remains uncommon and most patients ultimately undergo a total proctocolectomy with end ileostomy.

LIMITATIONS: 

Limited literature published, all retrospective in nature.

CONCLUSIONS: 

Despite significant advances in medical and surgical therapy in Crohn’s disease over the last decades, there is clearly an unmet need in the management of anorectal strictures in Crohn’s disease.

中文翻译：

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克罗恩病患者孤立肛门狭窄的处理

背景： 

肛门直肠狭窄是克罗恩病的一种特别病态的表现，导致与疼痛，大小便失禁和反复手术干预有关的生活质量下降。

目的： 

确定药物治疗，内窥镜扩张和外科手术对孤立性肛门直肠狭窄的治疗作用。

数据源： 

从1990年1月1日到2020年5月1日，对MEDLINE，PubMed，EMBASE，Scopus和Cochrane收集的评论数据库进行了有组织的搜索。

研究选择： 

全文，包括克罗恩氏病中孤立的肛门直肠狭窄的处理。

干预措施： 

医疗和外科手术管理。

主要观察指标： 

症状缓解，需要进行结肠切除术。

结果： 

我们的搜索共找到553篇论文；在根据标题（n = 430）和摘要（n = 47）进行排除之后，对76例患者进行了全文复查，其中65例与肛肠狭窄的治疗有关。回顾性报告的总结表明，药物治疗可以帮助控制腔内炎症，但是纤维化最终可能导致需要内窥镜或手术干预。由于炎症和溃疡以及伴随的肛周瘘管疾病，肛管的手术选择受到限制。尽管粪便转移可以缓解症状，但成功恢复肠道连续性仍然不常见，大多数患者最终都接受了全结肠直肠结肠切除术和回肠造口术。

局限性： 

出版的文献有限，本质上都是回顾性的。

结论： 

尽管过去几十年来克罗恩氏病的医学和外科治疗取得了显着进展，但显然在克罗恩氏病的肛门直肠狭窄处理中仍存在未满足的需求。