MR Imaging of Perianal Crohn Disease
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Perianal manifestations frequently develop in patients with Crohn disease (CD) and include skin tags, hemorrhoids, anal fissures, rectal ulcers, and perianal fistulas and abscesses. Long-term sequela including anorectal stricture or malignancy can also occur. Patients may have more than a single perianal manifestation but perianal fistula is the most prevalent. Unfortunately, most perianal fistulas in patients with CD will not spontaneously close. Treated fistulas usually heal slowly and are complicated by multiple relapses with postsurgical relapse rates estimated to be 30%–50%. Patients with perianal CD may experience a variety of symptoms, including pain, pruritus, malaise, chills, rigor, diarrhea, tenesmus, incontinence, sepsis, and high rates of anxiety and depression. This illustrative review summarizes current imaging strategies and objectives in patients with perianal CD focusing on modern therapeutic strategies and imaging findings, which will assist the gastroenterologist and surgeon in planning palliative or curative treatment options.

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