Perianal skin lesions, such as skin tags, can be an early presenting sign of Crohn’s disease. Surgical intervention on these lesions may increase the risk of fistula development and lead to worse outcomes. This case series examined 8 patients who underwent surgical intervention on what appeared to be benign perianal skin lesions, only to reveal fistulas leading to the diagnosis of Crohn’s disease. This patient population comprised 20% of all pediatric patients with Crohn’s disease who had perianal fistula present at diagnosis. The initial type of perianal lesion varied from case to case and included skin tags, hemorrhoids, and perianal abscesses. All of the patients had other presenting features that, in retrospect, may have been attributed to Crohn’s disease. None presented solely with a perianal lesion. Four patients had weight loss or growth failure. Most of the remainder had abnormal laboratory test results. These findings should raise the awareness of primary care providers that perianal lesions can be the first presenting sign of possible Crohn’s disease in otherwise healthy appearing children. Such children should undergo a thorough evaluation for Crohn’s disease before surgical intervention on perianal lesions because surgical procedures may be associated with worse outcomes.
Fistulizing Crohn’s Disease Presenting After Surgery on a Perianal Lesion
POTENTIAL CONFLICT OF INTEREST: Dr Adler has received funding from the Blue Cross Blue Shield of Michigan Foundation for other fistula research unrelated to this study; and the other authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
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Andrew A.M. Singer, Samir K. Gadepalli, Sally J. Eder, Jeremy Adler; Fistulizing Crohn’s Disease Presenting After Surgery on a Perianal Lesion. Pediatrics March 2016; 137 (3): e20152878. 10.1542/peds.2015-2878
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