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Perianal Crohn's disease — ESEGH MCQ

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HardInflammatory Bowel DiseasePerianal Crohn's diseaseESEGH

A 36-year-old woman with Crohn's disease reports perianal discharge and pain. Examination shows an external opening lateral to the anal verge and induration. CRP is 42 mg/L. MRI pelvis shows a trans-sphincteric fistula with a small intersphincteric collection. What is the most appropriate management?

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Correct answer: A — Examination under anaesthesia with drainage and seton placement

Complex perianal Crohn's fistula with sepsis requires EUA, drainage and seton placement before biologic optimisation. Fistulotomy through substantial sphincter risks incontinence. Topical therapy and mesalazine do not address complex fistulising disease. The pearl is that MRI pelvis and surgical sepsis control are central to perianal Crohn's management.

Reference: BSG IBD Guideline 2025; ECCO Perianal Crohn's Guidance