{"id":23255,"date":"2018-11-08T12:44:28","date_gmt":"2018-11-08T11:44:28","guid":{"rendered":"https:\/\/saintjoseph.agepcom.fr\/?post_type=service&p=12517"},"modified":"2022-05-03T10:33:24","modified_gmt":"2022-05-03T08:33:24","slug":"maladie-de-crohn","status":"publish","type":"service","link":"https:\/\/devhml.givememore.net\/specialites\/proctologie\/pathologies-2\/maladie-de-crohn\/","title":{"rendered":"Maladie de Crohn"},"content":{"rendered":"\n

La maladie de Crohn ano-p\u00e9rin\u00e9ale<\/h2>\n\n\n\n

La maladie de Crohn est une maladie inflammatoire chronique intestinale<\/strong> qui peut toucher tout le tube digestif de la bouche jusqu\u2019\u00e0 l\u2019anus. L\u2019atteinte ano-p\u00e9rin\u00e9ale de cette maladie est fr\u00e9quente (incidence cumulative sur 20 ans de 40 %) notamment en cas d\u2019atteinte rectale. Elle peut \u00eatre parfois la premi\u00e8re manifestation et constitue un facteur de mauvais pronostic de la maladie \u00e0 cause des difficult\u00e9s th\u00e9rapeutiques et du risque sur la continence anale.<\/p>\n\n\n\n

On distingue les l\u00e9sions primaires (ulc\u00e9rations, pseudo-marisques \u0153d\u00e9mateuses, l\u00e9sions m\u00e9tastatiques) qui refl\u00e8tent l\u2019activit\u00e9 de la maladie et les l\u00e9sions secondaires plus s\u00e9v\u00e8res (fistules simples ou complexes et st\u00e9noses) qui compliquent le cours \u00e9volutif de la maladie.<\/p>\n\n\n\n

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Les fistules crohniennes sont volontiers complexes avec des trajets hauts, inhabituels (trans-sphinct\u00e9riens et suprasphinct\u00e9riens) accompagn\u00e9s de multiples diverticules. L\u2019exemple de la fistule ano-vulvaire ou recto-vaginale, rarement observ\u00e9e en dehors de la maladie de Crohn, en est une preuve et constitue d\u2019ailleurs un des principaux d\u00e9fis th\u00e9rapeutiques.<\/p>\n\n\n\n

La prise en charge des l\u00e9sions ano-p\u00e9rin\u00e9ales de la maladie de Crohn est difficile et repose sur une concertation entre le proctologue qui doit s\u2019occuper de la mise \u00e0 plat des abc\u00e8s, du drainage souvent long des fistules, et le gastro-ent\u00e9rologue qui doit veiller \u00e0 une bonne optimisation du traitement m\u00e9dical de fond (principalement les anti-TNF associ\u00e9s ou non \u00e0 des immuno-suppresseurs) afin de permettre la gu\u00e9rison des ulc\u00e9rations et  la fermeture des fistules (cf encadr\u00e9).<\/p>\n\n\n\n

Nadia FATHALLAH<\/em><\/p>\n\n\n\n

——————- Encadr\u00e9<\/em> <\/strong>——————-<\/p>\n\n\n\n

  • La r\u00e9union de concertation multidisciplinaire<\/strong> pour les maladies inflammatoires chroniques intestinales.
    Nous avons mis en place au sein du Groupe hospitalier Paris Saint-Joseph une r\u00e9union de concertation multidisciplinaire pour les maladies inflammatoires chroniques intestinales.
    Il s\u2019agit une r\u00e9union bimestrielle regroupant proctologues, gastro-ent\u00e9rologues, chirurgiens digestifs et radiologues dont le but est de discuter de mani\u00e8re coll\u00e9giale de tous les dossiers des patients pr\u00e9sentant une maladie inflammatoire chronique intestinale (maladie de Crohn et recto-colite ulc\u00e9ro-h\u00e9morragique) qui posent des probl\u00e8mes de prise en charge th\u00e9rapeutique.
    A la suite de cette r\u00e9union, une fiche r\u00e9sumant l\u2019observation m\u00e9dicale ainsi que la d\u00e9cision th\u00e9rapeutique est class\u00e9e dans le dossier m\u00e9dical et envoy\u00e9e au m\u00e9decin correspondant.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"

    La maladie de Crohn ano-p\u00e9rin\u00e9ale La maladie de Crohn est une maladie inflammatoire chronique intestinale qui peut toucher tout le tube digestif de la bouche jusqu\u2019\u00e0 l\u2019anus. L\u2019atteinte ano-p\u00e9rin\u00e9ale de cette maladie est fr\u00e9quente (incidence cumulative sur 20 ans de 40 %) notamment en cas d\u2019atteinte rectale. Elle peut \u00eatre parfois la premi\u00e8re manifestation et […]<\/p>\n","protected":false},"author":25,"featured_media":0,"parent":22646,"menu_order":6,"template":"","meta":{"_acf_changed":false,"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":null,"stick-header-meta":null,"header-above-stick-meta":null,"header-main-stick-meta":null,"header-below-stick-meta":null,"astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"etablissements":[],"services":[],"class_list":["post-23255","service","type-service","status-publish","hentry"],"acf":[],"featured_img":false,"coauthors":[],"author_meta":{"author_link":"https:\/\/devhml.givememore.net\/author\/usersync\/","display_name":"usersync"},"relative_dates":{"created":"Publi\u00e9 8 ans il y a","modified":"Mis \u00e0 jour 4 ans il y a"},"absolute_dates":{"created":"Publi\u00e9 le 8 novembre 2018","modified":"Mise \u00e0 jour le 3 mai 2022"},"absolute_dates_time":{"created":"Publi\u00e9 le 8 novembre 2018 12 h 44 min","modified":"Mise \u00e0 jour le 3 mai 2022 10 h 33 min"},"featured_img_caption":"","tax_additional":{"etablissements":{"linked":[],"unlinked":[],"slug":"etablissements","name":"\u00c9tablissements"},"services":{"linked":[],"unlinked":[],"slug":"services","name":"Services"}},"series_order":"","_links":{"self":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/23255","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service"}],"about":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/types\/service"}],"version-history":[{"count":2,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/23255\/revisions"}],"predecessor-version":[{"id":23351,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/23255\/revisions\/23351"}],"up":[{"embeddable":true,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/22646"}],"wp:attachment":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/media?parent=23255"}],"wp:term":[{"taxonomy":"etablissements","embeddable":true,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/etablissements?post=23255"},{"taxonomy":"services","embeddable":true,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/services?post=23255"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}