A 50-year-old man with a history of perianal Crohn's disease presents with multiple complex fistulas. Examination under anaesthesia reveals a high transsphincteric fistula with the internal opening at the dentate line. What is the most appropriate initial surgical management?

• A Fistulotomy with primary sphincter repair
• B Fibrin glue injection
• C Endorectal advancement flap repair
• D Placement of a non-cutting seton drain ✓

Explanation

In Crohn's disease with a high transsphincteric fistula, the initial management is a non-cutting seton to provide drainage, control sepsis, and preserve sphincter function. Fistulotomy in active Crohn's risks poor healing and incontinence. Endorectal advancement flap is considered after disease control with biologics, not as initial management. Fibrin glue has low success rates in complex Crohn's fistulas.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.