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Hyder SA, Travis SPL, Jewel DP, et al. Fistulating anal Crohn’s disease: results of combined surgical and infliximab treatment. Dis Colon Rectum 2006;49:1837–41.[CrossRef][Medline]
Fistulating Crohn’s disease remains a therapeutic challenge and a considerable burden to many patients. Treatment with agents such as infliximab held great promise but recent reports of life threatening infection are a concern. The combination of occult or undrained sepsis and powerful immunomodulation is not to be taken lightly and, as in other aspects of Crohn’s disease, merits a multidisciplinary approach.
Recognising this, the Oxford group has used a combination of immunosuppression (azathioprine or methotrexate), selective magnetic resonance imaging (MRI) scanning and examination under anaesthetic (EUA), with appropriate drainage of sepsis and insertion of seton sutures followed by early infliximab (seton sutures were removed on the second induction dose at 2 weeks). This study reports the outcome in 22 patients
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