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Chirurgia 2018 December;31(6):247-53

DOI: 10.23736/S0394-9508.18.04810-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Endoanal ultrasound for perianal Crohn’s disease: is there correlation with fecal incontinence?

Umberto MORELLI 1 , Luís A. MAGNA 2, Claudio S. RODRIGUES COY 1, Raquel FRANCO LEAL 1, Maria de LOURDES SETSUKO AYRIZONO 1

1 Coloproctology Unit, Department of Surgery, School of Medical Sciences, University of Campinas (uNiCaMP), São Paulo, Brazil; 2 Department of Genetics, School of Medical Sciences, University of Campinas (uNiCaMP), São Paulo, Brazil


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BACKGROUND: The incidence of perianal Crohn’s disease (PCD) is variable between 20% and 25% of patients with Crohn’s disease (CD). The assessment of PCD consists in clinical examination followed eventually by examination under anesthesia. Our aim was to verify if a clinical evaluation using the Jorge-Wexner Score to assess fecal incontinence in patients with PCD is correlated to real anatomical defects, assessed with the use of endoanal ultrasound (EAUS) and Starck Score for sphincteric lesions.
METHODS: Cohort study that included patients aged over 18, both genders, an established diagnosis of PCD, was performed. All patients were submitted to a standard outpatient clinical evaluation and to a questionnaire to calculate the Jorge-Wexner Score for fecal incontinence and to a 2D and 3D EAUS. The Starck Score was calculated for each exam.
RESULTS: Twenty-four patients were included, 16 females and 8 males, mean age 40.54 years old. Seven (29.16%) have small bowel CD, 7 (29.16%) large bowel CD, 2 (8.33%) both small and large bowel CD, and in 8 patients (33.33%) PCD was the only clinical manifestation of CD. Both scores had a normal distribution, with a mean Wexner Score of 3.83±4.52 and a mean Starck Score of 9.75±2.54). There is no statistical correlation between the two scores with a confidence interval of 95%.
CONCLUSIONS: The Jorge-Wexner Score use in clinical practice in PCD patients is not advised for therapeutic management and planning, whereas EAUS was a useful tool to manage this subpopulation of patients.


KEY WORDS: Crohn disease - Ultrasonography - Inflammatory bowel diseases - Rectal fistula - Fecal incontinence

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