Non-fistulizing anoperineal lesions in Crohn’s disease: a practical review and therapeutic implications

Despite their frequency, non-fistulizing perianal lesions in Crohn’s disease remain underexplored. In contrast to fistulas and abscesses, their management is based on poorly standardized data. Their polymorphic clinical presentation can delay diagnosis. Clinical examination is essential and should be complemented by pelvic MRI to exclude underlying complications such as fistulas or abscesses. Treatment primarily relies on anti-TNFα agents, often in combination with immunosuppressants. Other biologic therapies, including JAK inhibitors, offer promising prospects, despite a low level of evidence with limited clinical data on non-fistulizing lesions available. Surgery is reserved for fibrotic lesions or degenerative complications. Long-term follow-up is mandatory due to the risk of anal cancer in chronic cases. This mini review provides a practical overview of the diagnostic, evaluative, and therapeutic strategies for these underrecognized manifestations of perianal Crohn’s disease.