Diagnosis and treatment of fistulising XXXX .

@entity1 @entity500 @entity4446 @entity292 @entity733 @entity30
A @entity292 is defined as a pathological connection between the intestine and an inner (bladder or other intestine) or outer (vagina or skin) epithelial surface. @entity292 are discovered in up to 25% of all @entity30 @entity1 during long-term follow-up examinations. Most are perianal @entity292 , and these may be classified as simple or complex. The initial investigation of perianal @entity292 includes imaging (MRI of the pelvis and rectum), examination under anaesthesia (EUA) with digital imaging, endoscopy, probing and anal ultrasound. Non-perianal @entity292 require contrast imaging and/or CT/MRI for complete anatomical definition. Any @entity733 should be drained, and the disease extent throughout the entire gastrointestinal tract should be evaluated. Treatment goals for perianal @entity292 include reduced @entity292 secretion or none, evaluated by clinical examination; the absence of abscesses; and @entity1 satisfaction. MR imaging is required to demonstrate definitive @entity292 closure. Fistulotomy is considered for simple perianal @entity292 . In complex perianal @entity292 , antibiotics and @entity500 or @entity4446 , which are often combined with a loose seton, constitute the first-line medical therapy. In cases with persistent secretion, infliximab at 5 mg/kg is given at weeks 0, 2, and 6 and subsequently every 8 weeks. Adalimumab may improve @entity292 response in both infliximab-na  ve @entity1 and following infliximab treatment failure. Local therapy with fibrin glue or @entity292 plugs is rarely effective. Definitive surgical closure of perianal @entity292 using an advancement flap may be attempted, but this procedure is associated with a high risk of relapse. Colostomy and proctectomy are the ultimate surgical treatment options for @entity292 . Intestinal resection is almost always needed for the closure of symptomatic non-perianal @entity292 .
