Perianal disease is one of the most disabling manifestations of Crohn's disease. A
multidisciplinary approach of gastroenterologist, colorectal surgeon and radiologist is
necessary for its management. A correct diagnosis, based on endoscopy, magnetic
resonance imaging, endoanal ultrasound and examination under anesthesia, is crucial for
perianal fistula treatment. Available medical and surgical therapies are discussed in this
review, including new local treatment modalities that are under investigation.

Background: Perianal fistulizing Crohn's disease is associated with severe symptoms such
as pain, fecal incontinence, and a significant reduction in quality of life. Results: In refractory
cases, many patients face the decision of having a stoma and/or requiring proctectomy. In
former years, the standard of care was a complete fistulectomy, bringing with it a high rate of
continence disorders. Additionally, many patients received indefinite treatment, namely the
placement of a seton to maintain surgical drainage. Conclusion: More recently, newer …