Summary
A case is reported in which a comprehensive program of hyperbaric oxygen (HBO), surgical debridement and reconstruction, and continuing medical management resulted in complete and sustained closure of an extensive perineal Crohn's lesion refractory to conventional medical and surgical management. It is emphasized that in this case healing occurred in the setting of previous removal of all diseased intestinal tissue and only with the combined use of all three treatment modalities. HBO may be a useful adjunct in the therapy of large nonhealing perineal lesions postproctocolectomy in patients who are unresponsive to metronidazole or to immunosuppressant therapy or who experience limiting side effects from continued medical therapy.
Similar content being viewed by others
References
Ursing B, Kamme C: Metronidazole for Crohn's disease. Lancet 1:775–777, 1975
Allan R, Cooke WT: Evaluation of metronidazole in the management of Crohn's disease. Gut 18:A422, 1977
Ursing B: Metronidazole in the treatment of Crohn's disease. Scand J Gastroenterol 15:(suppl 58): 117, 1980
Bernstein LH, Frank MS, Brandt LJ, Boley SJ: Healing of perineal Crohn's disease with metronidazole. Gastroenterology 79:357–365, 1980
Rosen A, Ursing B, Alm T, Barany F, Bergelin I, Ganrot-Norlin K, Hoevels I, Huitfeldt B, Jarnerst G, Krause V, Krook A, Lindstrom B, Nordle O: A comparative study of metronidazole and sulfasalazine for active Crohn's disease: The Cooperative Crohn's Disease Study in Sweden. Gastroenterology 83:541–562, 1982
Brandt LJ, Bernstein LH, Boley SJ, Frank MS: Metronidazole therapy for perineal Crohn's disease: A follow-up study. Gastroenterology 83:283–287, 1982
Goldstein F: Immunosuppresant therapy in inflammatory bowel disease. J Clin Gastroenterol 9(6):654–658, 1987
Summus R, Switz D, Sessions J, Becktel J, Best W, Kern F, Singleton J: National Cooperative Crohn's Disease Study: Results of drug treatment. Gastroenterology 77:847–869, 1979
Korelitz B, Present D: Shortcomings of the National Crohn's Disease Study: The exclusion of azathioprine without adequate trial. Gastroenterology 80:193–194, 1981
Korelitz B, Present D: Favorable effect of 6-mercaptopurine on fistulas of Crohn's disease. Dig Dis Sci 30(1):58–64, 1985
Mekhjian HS, Switz DM, Watts DH, Derin JJ, Katon RM, Berrnan FM: National Cooperative Crohn's Disease Study: Factors determining recurrence of Crohn's disease after surgery. Gastroenterology 77:907–913, 1979
Corman ML, Veidenheimer MC, Coller JA, Ross VH: Perineal wound healing after proctectomy for inflammatory bowel disease. Dis Colon Rectum 21(3):155–159, 1978
McIlrath DC: Diverting ileostomy or colostomy in the management of Crohn's disease of the colon. Arch Surg 103:308–310, 1971
Baker WN, Milton-Thompson GJ: Management of anal fistulae in Crohn's disease. Proc R Soc Med 67:58, 1974
Silen W, Glotzer DJ: The prevention and treatment of the persistent perineal sinus. Surgery 75:535–542, 1974
Shaw A, Futrell JW: Cure of chronic perineal sinus with gluteus maximus flap. Surg Gynecol Obstet 147:417–422, 1978
Anderson R, Turnbull RB: Grafting the unhealed perineal wound after coloproctectomy for Crohn's disease. Arch Surg 111:335–338, 1976
Gray BK, Lockhart-Mummery HE, Morson BC: Crohn's disease of the anal region. Gut 6:515–524, 1965
McCallum DI, Gray WM: Metastatic Crohn's disease. Br J Dermatol 95(5):551–554, 1976
Krook A, Jarnerot G, Danielson D: Clinical effect of metronidazole and sulphasalazine on Crohn's disease in relation to changes in the fecal flora. Scand J Gastroenterol 16:569–575, 1981
Grove DI, Mahmoud AAF, Warren KS: Suppression of cell-mediated immunity by metronidazole. Int Arch Allergy Appl Immunol 54:422–427, 1977
Gnarpe H, Persson S, Belsheim J: Influence of metronidazole and tinidazole in leucocyte chemotaxis in Crohn's disease. Infection 6(suppl 1): 107–109, 1978
Editorial. Metronidazole—unanswered questions. Lancet 1:818–819, 1981
Rolfe RD, Hentges DJ, Campbell BJ, Barrett JT: Factors related to the oxygen tolerance of anaerobic bacteria. Appl Environ Microbiol 36:306–313, 1978
Hill GB: Hyperbaric oxygen exposure for intrahepatic abscesses produced in mice by non spore forming anaerobic bacteria. Antimicrob Agents Chemother 9(2):312–317, 1976
Tonjum S, Svanes K, Alho A, Hofstad T: The effect of hyperbaric oxygenation on experimentalBacteroides fragilis infection in the rat liver. Acta Chir Scand 147:347–351, 1981
Darke SG, King AM, Slack WK: Gas gangrene and related infections: Classification, clinical features and etiology, management and mortality. A report of 88 cases. Br J Surg 64:104–112, 1977
Schreiner A, Tonjum S, Dignares A: Hyperbaric oxygen therapy in bacteroides infections. Acta Chir Scand 140:73–76, 1974
Gabb G, Robin ED: Hyperbaric oxygen: A therapy in search of a disease. Chest 92(6): 1074–1082, 1987
Myers RAM, Schnitzer BM: Hyperbaric oxygen use update 1984. Postgrad Med 76(5):83–95, 1984
Mader JT, Brown GL, Guckian JC, Wells CH, Reinarz JA: A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis 142:915–922, 1980
Babior BM: Oxygen-dependent microbial killing by phagocytes. N Engl J Med 8659–668, 721–726, 1974
Hunt TK, Pai MP: The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet 135:561–567, 1972
Winter GD, Perrins DJD: Effects of hyperbaric oxygen treatment on epidermal regeneration.In Proceedings of the Fourth International Congress on Hyperbaric Medicine. J Wada, T Iwa (eds). Baltimore, Williams & Wilkins, 1970, pp 363–368
Davis J: Hyperbaric oxygen therapy. A committee report. Bethesda, Undersea Medical Society, 1983
Davis JC, Landeen JM, Levine RA: Pyoderma gangrenosum: Skin grafting after preparation with hyperbaric oxygen. Plast Reconstr Surg 79(2): 200–207, 1987
Wada J, Iwa T: Proceedings of the Fourth International Congress on Hyperbaric Medicine. Baltimore, Williams & Wilkins, 1970, p 542
Brady III CE, Cooley BJ, Davis JC: Healing severe perineal and cutaneous Crohn's disease with hyperbaric oxygen. Gastroenterology 97:756–760, 1989
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nelson, E.W., Bright, D.E. & Villar, L.F. Closure of refractory perineal Crohn's lesion. Digest Dis Sci 35, 1561–1565 (1990). https://doi.org/10.1007/BF01540577
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01540577