Skip to main content
Log in

Closure of refractory perineal Crohn's lesion

Integration of hyperbaric oxygen into case management

  • Case Report
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ursing B, Kamme C: Metronidazole for Crohn's disease. Lancet 1:775–777, 1975

    PubMed  Google Scholar 

  2. Allan R, Cooke WT: Evaluation of metronidazole in the management of Crohn's disease. Gut 18:A422, 1977

    Google Scholar 

  3. Ursing B: Metronidazole in the treatment of Crohn's disease. Scand J Gastroenterol 15:(suppl 58): 117, 1980

    Google Scholar 

  4. Bernstein LH, Frank MS, Brandt LJ, Boley SJ: Healing of perineal Crohn's disease with metronidazole. Gastroenterology 79:357–365, 1980

    PubMed  Google Scholar 

  5. 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

    PubMed  Google Scholar 

  6. Brandt LJ, Bernstein LH, Boley SJ, Frank MS: Metronidazole therapy for perineal Crohn's disease: A follow-up study. Gastroenterology 83:283–287, 1982

    Google Scholar 

  7. Goldstein F: Immunosuppresant therapy in inflammatory bowel disease. J Clin Gastroenterol 9(6):654–658, 1987

    PubMed  Google Scholar 

  8. 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

    PubMed  Google Scholar 

  9. Korelitz B, Present D: Shortcomings of the National Crohn's Disease Study: The exclusion of azathioprine without adequate trial. Gastroenterology 80:193–194, 1981

    PubMed  Google Scholar 

  10. Korelitz B, Present D: Favorable effect of 6-mercaptopurine on fistulas of Crohn's disease. Dig Dis Sci 30(1):58–64, 1985

    PubMed  Google Scholar 

  11. 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

    PubMed  Google Scholar 

  12. 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

    PubMed  Google Scholar 

  13. McIlrath DC: Diverting ileostomy or colostomy in the management of Crohn's disease of the colon. Arch Surg 103:308–310, 1971

    PubMed  Google Scholar 

  14. Baker WN, Milton-Thompson GJ: Management of anal fistulae in Crohn's disease. Proc R Soc Med 67:58, 1974

    Google Scholar 

  15. Silen W, Glotzer DJ: The prevention and treatment of the persistent perineal sinus. Surgery 75:535–542, 1974

    PubMed  Google Scholar 

  16. Shaw A, Futrell JW: Cure of chronic perineal sinus with gluteus maximus flap. Surg Gynecol Obstet 147:417–422, 1978

    PubMed  Google Scholar 

  17. Anderson R, Turnbull RB: Grafting the unhealed perineal wound after coloproctectomy for Crohn's disease. Arch Surg 111:335–338, 1976

    PubMed  Google Scholar 

  18. Gray BK, Lockhart-Mummery HE, Morson BC: Crohn's disease of the anal region. Gut 6:515–524, 1965

    PubMed  Google Scholar 

  19. McCallum DI, Gray WM: Metastatic Crohn's disease. Br J Dermatol 95(5):551–554, 1976

    PubMed  Google Scholar 

  20. 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

    PubMed  Google Scholar 

  21. Grove DI, Mahmoud AAF, Warren KS: Suppression of cell-mediated immunity by metronidazole. Int Arch Allergy Appl Immunol 54:422–427, 1977

    PubMed  Google Scholar 

  22. 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

    Google Scholar 

  23. Editorial. Metronidazole—unanswered questions. Lancet 1:818–819, 1981

  24. Rolfe RD, Hentges DJ, Campbell BJ, Barrett JT: Factors related to the oxygen tolerance of anaerobic bacteria. Appl Environ Microbiol 36:306–313, 1978

    PubMed  Google Scholar 

  25. 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

    PubMed  Google Scholar 

  26. 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

    PubMed  Google Scholar 

  27. 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

    PubMed  Google Scholar 

  28. Schreiner A, Tonjum S, Dignares A: Hyperbaric oxygen therapy in bacteroides infections. Acta Chir Scand 140:73–76, 1974

    PubMed  Google Scholar 

  29. Gabb G, Robin ED: Hyperbaric oxygen: A therapy in search of a disease. Chest 92(6): 1074–1082, 1987

    PubMed  Google Scholar 

  30. Myers RAM, Schnitzer BM: Hyperbaric oxygen use update 1984. Postgrad Med 76(5):83–95, 1984

    Google Scholar 

  31. 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

    PubMed  Google Scholar 

  32. Babior BM: Oxygen-dependent microbial killing by phagocytes. N Engl J Med 8659–668, 721–726, 1974

    Google Scholar 

  33. Hunt TK, Pai MP: The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet 135:561–567, 1972

    PubMed  Google Scholar 

  34. 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

    Google Scholar 

  35. Davis J: Hyperbaric oxygen therapy. A committee report. Bethesda, Undersea Medical Society, 1983

    Google Scholar 

  36. Davis JC, Landeen JM, Levine RA: Pyoderma gangrenosum: Skin grafting after preparation with hyperbaric oxygen. Plast Reconstr Surg 79(2): 200–207, 1987

    PubMed  Google Scholar 

  37. Wada J, Iwa T: Proceedings of the Fourth International Congress on Hyperbaric Medicine. Baltimore, Williams & Wilkins, 1970, p 542

    Google Scholar 

  38. Brady III CE, Cooley BJ, Davis JC: Healing severe perineal and cutaneous Crohn's disease with hyperbaric oxygen. Gastroenterology 97:756–760, 1989

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01540577

Key words

Navigation