title: Fistulizing Crohn's disease: Diagnosis and management.
abstract: Fistulizing Crohn's disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn's disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands ; Robarts Clinical Trials, Amsterdam, the Netherlands.
authors.forename: Krisztina
authors.initials: K
authors.lastname: Gecse
authors.affiliation: Robarts Clinical Trials, London, ON, Canada.
authors.forename: Reena
authors.initials: R
authors.lastname: Khanna
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.affiliation: Department of Surgery, St. Mark's Hospital, Harrow, London, UK.
authors.forename: John T
authors.initials: JT
authors.lastname: Jenkins
authors.affiliation: The Lennard-Jones Intestinal Failure Unit, St. Mark's Hospital, Harrow, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gabe
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands ; Robarts Clinical Trials, Amsterdam, the Netherlands.
authors.forename: Geert
authors.initials: G
authors.lastname: D'Haens
keywords: Crohn’s disease; anti-TNF therapy; enterocutaneous fistula; inflammatory bowel disease; perianal fistula