Perianal Crohn's disease: Imaging and new therapeutic frontiers

Perianal fistulas in patients with Crohn’s disease are frequent and represent a particularly debilitating and aggressive phenotype. The diagnosis is essentially clinical, however imaging techniques, such as endoanal ultrasound and pelvic magnetic resonance, are useful for diagnostic confirmation and for anatomic definition of the fistulas. The treatment of perianal Crohn’s disease is complex and requires a personalised, inter-disciplinary approach. New therapeutic alternatives, such as cellular treatment with mesenchymal stem cells, are a promising option for patients with refractory perianal disease or with inadequate response to treatment with biologics.