A Preliminary Study On The Clinical Features And Imaging Diagnosis Of Anorectal Stenosis In Crohn’s Disease

Objective:To summarize the clinical features of(CD)anorectal stenosis in Crohn’s disease.To explore the value of balloon magnetic resonance(MRI)in the diagnosis of anorectal stenosis in CD.Methods:In order to analyze the clinical characteristics of CD anorectal stenosis,the data of 96 patients with CD anorectal stenosis in the anorectal Department of Jiangsu Hospital of traditional Chinese Medicine from November 2010 to November 2019 were collected retrospectively.In order to explore the value of balloon MRI in the diagnosis of CD anorectal stenosis,15 patients with CD anorectal stenosis were prospectively collected from the Department of anorectal surgery of the affiliated Hospital of Nanjing University of traditional Chinese Medicine from September 2018 to November 2019.All patients underwent balloon MRI examination and measured the length of the superior edge of the stenosis ring to the anal edge on imaging and the length of the upper edge of the stenosis ring to the anal edge during the operation.The coincidence rate of the length measured by balloon MRI was evaluated.Results:1.The ratio of male to female in 96 patients was about 1.1315,and the age of diagnosis was(31.93±9.15)years.Patients with previous history of abdominal surgery,perianal surgery and drug treatment accounted for 32.3%,65.6%and 87.5%,respectively.The ileocolon type accounted for 63.6%of the lesions.The patients with single stenosis,complex stenosis,tubular stenosis and severe stenosis accounted for 62.5%,70.8%,71.9%and 54.2%of the patients with anal fistula,respectively.One patient(1.0%)developed canceration.28.1%of the patients had symptoms of defecation difficulty.47.9%of the patients had abnormal body mass index((BMI)).57.3%of the patients’CD activity index(CDAI)was in the active stage,and 52.1%of the patients’ perianal lesion activity index(PDAI)was in the active stage.50%of the patients’C-reactive protein(CRP)was higher than the normal value,and 61.5%of the patients’ erythrocyte sedimentation rate(ESR)was higher than the normal value.Univariate analysis showed that previous abdominal surgery,PDAI,CRP and platelet(PLT)were risk factors for the degree of anorectal stenosis in CD,while sex,previous abdominal surgery,course of CD and course of anorectal stenosis were risk factors for the type of anorectal stenosis(single and multiple stenosis)in CD.Logistic regression analysis showed that previous abdominal surgery(OR=14.258,95%CI:1.693-120.064)and PDAI(OR=0.269,95%CI:0.084-0.859)were independent risk factors for the degree of anorectal stenosis in CD.Gender and course of anorectal stenosis(OR=4.130,95%CI:1.688-10.102)were independent risk factors for the type of anorectal stenosis(single and multiple stenosis)in CD.2.15 cases of CD anorectal stenosis,male 6 cases,female 9 cases,the age of treatment was 24Rue 54 years old,(34.53±9.03)years old,BMI fluctuation between 17.02-28.01kg/m2,(20.13±3.37)kg/m2,had a history of perianal surgery in 12 cases(80%),4 cases had a history of abdominal surgery(26.7%).There was no significant difference between the two groups in measuring the length of the superior edge of the stenosis ring from the anal edge by balloon MRI and the length of the superior edge of the stenosis ring between the two groups during operation(P>0.05).Conclusion:1.CD patients with anorectal stenosis are young,slightly more male than female,and ileocolon type is more common,mainly stenosis type(type B2)and stenosis and penetrating type(type B2B3).Difficulty in defecation is the most common clinical symptom.Patients often have a history of abdominal surgery and perianal abscess and anal fistula,are easy to be complicated with anal fistula,and have the risk of cancerization.Strictures are mostly single strictures,and multiple strictures are easy to be complicated with colonic strictures.Complex stenosis,tubular stenosis and severe stenosis are more common.CD anorectal stenosis is mostly located between the tooth line and the anorectal line,and the stenosis length is less than 4cm.There are many abnormalities in inflammation and nutrition indexes in laboratory examination.In addition,the previous history of abdominal surgery and the active stage of PDAI are more likely to develop severe stenosis,and the longer the course of anorectal stenosis in men and the longer the course of anorectal stenosis,the more likely to form multiple stenosis.2.Balloon MRI can be used to evaluate the length of the superior edge of the stenosis ring to the anal margin before CD anorectal stenosis,which provides a new method for clinical evaluation of CD anorectal stenosis.