Combined approach with biologics and surgery for enterocutaneous fistulas in Crohnʼs disease

Fries, Walter; Malfa, Giuseppe La; Costantino, Giuseppe; Repici, Alessandro; Mazziotti, Silvio; Navarra, Giuseppe

doi:10.1002/ibd.21289

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…There is a retrospective Canadian study with more than 50 patients in which the authors concluded that surgery was the best option in these patients (10). Fries et al presented three cases of patients with stenosing CD who, after requiring bowel surgery, developed ECF that was treated with combination anti-TNF agents and surgery with good results (11). A good medical-surgical combination with monitoring of times may be the best treatment option in these patients.…”

Section: Discussionmentioning

confidence: 99%

Enterocutaneous fistulas and Crohn's disease: Clinical characteristics and response to treatment

Gómez-Senent

Acosta

García–Sánchez³

2013

Rev. esp. enferm. dig.

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Section: Discussionmentioning

confidence: 99%

Enterocutaneous fistulas and Crohn's disease: Clinical characteristics and response to treatment

Gómez-Senent

Acosta

García–Sánchez³

2013

Rev. esp. enferm. dig.

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“…In the last decade, medical therapy changed with introduction of biologics and immunomodulators. Following experience with perianal inflammatory disease, monoclonal antibodies against tumour necrosis factor are increasingly used: with correct patient selection, in the absence of stenosis and complex fistulas, infliximab achieves good response in postoperative and, to a minor extent, spontaneous ECFs too [ 16 , 21 , 22 ].…”

Section: Enterocutaneous Fistulas In Chronic Inflammatory Bowel Diseamentioning

confidence: 99%

Enterocutaneous fistulas: a primer for radiologists with emphasis on CT and MRI

Tonolini

Magistrelli

2017

Insights Imaging

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Enterocutaneous fistulas (ECFs) represent abnormal communications between the gastrointestinal tract and the skin. Nowadays, the majority (~80%) of ECFs develops secondary to abdominal surgeries; alternative, less common causes include chronic inflammatory bowel diseases (IBD) such as Crohn’s disease, tumours, and radiation enteritis in descending order of frequency. These rare disorders require thorough patient assessment and multidisciplinary management to limit the associated morbidity and mortality. This pictorial review includes an overview of causes, clinical manifestations, complications and management of ECFs. Afterwards, the imaging appearances, differential diagnoses, and therapeutic options of post-surgical, IBD-related, and malignant ECFs are presented with case examples. Most of the emphasis is placed on the current pivotal role of CT and MRI, which comprehensively depict ECFs providing cross-sectional information on the underlying postsurgical, neoplastic, infectious, or inflammatory conditions. Radiographic fistulography remains a valid technique, which rapidly depicts the ECF anatomy and confirms communication with the bowel. The aim of this paper is to increase radiologists’ familiarity with ECF imaging, thus allowing an appropriate choice between medical, interventional, or surgical treatment, ultimately resulting in higher likelihood of therapeutic success.Teaching Points• Enterocutaneous fistulas may complicate abdominal surgery, sometimes Crohn’s disease and tumours.• The high associated morbidity and mortality result from sepsis, malnutrition and metabolic imbalance.• The multidisciplinary management of ECFs requires thorough imaging for correct therapeutic choice.• Radiographic fistulography rapidly depicts fistulas and communicating bowel loops in real-time.• Multidetector CT and MRI provide cross-sectional information on fistulas and underlying diseases.

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“…In the patient with abdominal wall sepsis, it may be initially necessary to drain any intervening abscess to allow for the local sepsis to abate. 31,32 At the time of a planned intervention for an enterocutaneous fistula, appropriate surgical management consists of resection of the primary disease with debridement of the fistulous tract through the abdominal wall. 30 Specifically, the timing is best when the local inflammatory response has subsided as much as possible and the abdominal wall, initially doughy, has become soft.…”

Section: Technical Challenges Of Small Bowel Crohn Disease Fistulaementioning

confidence: 99%

Surgical Treatment of Complex Small Bowel Crohn Disease

Michelassi

Sultan

2014

Annals of Surgery

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Although the principles of modern surgical treatment of Crohn disease have evolved to bowel conservation such as strictureplasty techniques and limited resection margins, such practices by themselves are often not sufficient for the management of complex small bowel Crohn disease. This manuscript reviews each category of complex small bowel Crohn disease, with special emphasis on appropriate surgical strategy.

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Combined approach with biologics and surgery for enterocutaneous fistulas in Crohnʼs disease

Cited by 6 publications

References 10 publications

Enterocutaneous fistulas and Crohn's disease: Clinical characteristics and response to treatment

Enterocutaneous fistulas and Crohn's disease: Clinical characteristics and response to treatment

Enterocutaneous fistulas: a primer for radiologists with emphasis on CT and MRI

Surgical Treatment of Complex Small Bowel Crohn Disease

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