Abdominoperineal Resection of the Rectum With Enlargement in a Case of Complex Perineal Crohn's Disease With Delayed Healing
Year: 2024
Type: article
Study design: Case Report
Abstract: Case Presentation A 26-year-old male patient, diagnosed with Crohn’s Disease (Montreal A2L2B3p), presented to the coloproctology outpatient clinic 7 years ago with complaints of perineal pain, colic, and diarrhea with mucus. He was treated with azathioprine, immunobiologics, and multiple perianal surgeries, but did not achieve complete perineal healing. After 5 years of follow-up, he developed rectal stenosis and extensive anal fibrosis with an open and purulent wound. Abdominoperineal resection of the rectum was indicated. Postoperatively, the patient had delayed and inefficient healing of the perineal wound, largely due to his systemic conditions, especially nutritional issues. He underwent 35 sessions of hyperbaric oxygen therapy (HBOT), resulting in partial healing. During this period, the disease recurred in the transverse colon, leading to another colectomy with terminal ileostomy and perineal resuture. An additional 14 sessions of HBOT were performed, with good healing and disease control. After healing, the patient gained 33 kg in weight over 6 months. Discussion Crohn’s Disease affects various regions of the gastrointestinal tract, but the most challenging complications arise when it involves the perianal region. Despite various adjunctive treatments and local surgical interventions, there is a significant risk of developing irreversible anorectal fibrosis and subsequent rectal amputation, which can occur in up to 15% of patients, as seen in this case. What stood out the most, however, was the prolonged and ineffective healing of the postoperative wound due to the patient’s malnutrition, requiring a total of 49 HBOT sessions, as well as the recurrence of the disease and the need for another colectomy. This was a high-complexity case that ultimately resulted in satisfactory outcomes and improved the patient's quality of life. Conclusion This case illustrates the most challenging complications of Crohn’s Disease in its perianal form and emphasizes the importance of continuous monitoring and frequent adjustments in the therapeutic plan, adapting to the disease's progression and the patient’s individual response to treatment. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
Source: Journal of Coloproctology
Authors: Rafael Andrade Cruz, Vinícius Miranda Baroni, Bárbara Máximo Nascimento, Artur Cury Féres, Marley Ribeiro Feitosa, Rogério Serafim Parra, José Joaquim Ribeiro da Rocha, Omar Féres
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Genetics
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W4409791757