Background: Few studies describe the radiological and laboratory characteristics of patients with Crohn’s disease (CD) with intra-abdominal fistulae. Objectives: We aimed to describe a cohort of CD patients with intra-abdominal fistulae and determine characteristics associated with complex fistulae. Methods: Data were gathered from medical records and imaging studies of patients. Evaluation included type of fistula, number of fistulae, and radiological characteristics. Results: A total of 205 fistulae in 132 patients were identified with an average patient age of 31 (±12) years. The average time from CD diagnosis to fistula development was 7 years. The most common type of fistula was entero-enteric (53%). Patients with an extra-intestinal fistula presented with an average of 1.96 fistulae, compared with an average of 1.28 fistulae for those with a fistula limited to the bowel (p=0.01). Except for the number of fistula no other significant differences were observed in radiological characteristics of patients who were diagnosed with a fistula at time of CD diagnosis compared to those diagnosed with a fistula later. Conclusions: The most common CD-associated intra-abdominal fistulae are entero-enteric and entero-colonic fistulae. An extra-intestinal fistula and diagnosis of a fistula subsequent to diagnosis of CD were associated with an increased number of fistulae per patient.

1.
Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus EV Jr. Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort. Gastroenterology. 2010 Oct;139(4):1147–55.
2.
Bell SJ, Williams AB, Wiesel P, Wilkinson K, Cohen RC, Kamm MA. The clinical course of fistulating Crohn’s disease. Aliment Pharmacol Ther. 2003 May;17(9):1145–51.
3.
Schwartz DA, Loftus EV Jr, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology. 2002 Apr;122(4):875–80.
4.
Wang GF, Ren JA, Liu S, Chen J, Gu GS, Wang XB, et al. Clinical characteristics of non-perianal fistulating Crohn’s disease in China: a single-center experience of 184 cases. Chin Med J (Engl). 2012 Jul;125(14):2405–10.
5.
Levy C, Tremaine WJ. Management of internal fistulas in Crohn’s disease. Inflamm Bowel Dis. 2002 Mar;8(2):106–11.
6.
Yoon YS, Yu CS, Yang SK, Yoon SN, Lim SB, Kim JC. Intra-abdominal fistulas in surgically treated Crohn’s disease patients. World J Surg. 2010 Aug;34(8):1924–9.
7.
Nielsen OH, Rogler G, Hahnloser D, Thomsen OO. Diagnosis and management of fistulizing Crohn’s disease. Nat Clin Pract Gastroenterol Hepatol. 2009 Feb;6(2):92–106.
8.
Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC, et al. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohn’s Colitis. 2013 Aug;7(7):556–85.
9.
Moon CM, Jung SA, Kim SE, Song HJ, Jung Y, Ye BD, et al.; CONNECT study group. Clinical Factors and Disease Course Related to Diagnostic Delay in Korean Crohn’s Disease Patients: results from the CONNECT Study. PLoS One. 2015 Dec;10(12):e0144390.
10.
D’Haens G. Medical management of major internal fistulae in Crohn’s disease. Inflamm Bowel Dis. 2000 Aug;6(3):244–5.
11.
Lichtenstein GR, Yan S, Bala M, Blank M, Sands BE. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology. 2005 Apr;128(4):862–9.
12.
Yaari S, Benson A, Aviran E, Lev Cohain N, Oren R, Sosna J, et al. Factors associated with surgery in patients with intra-abdominal fistulizing Crohn’s disease. World J Gastroenterol. 2016 Dec;22(47):10380–7.
13.
Colombel JF, Solem CA, Sandborn WJ, Booya F, Loftus EV Jr, Harmsen WS, et al. Quantitative measurement and visual ­assessment of ileal Crohn’s disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein. Gut. 2006 Nov;55(11):1561–7.
14.
Tang LY, Rawsthorne P, Bernstein CN. Are perineal and luminal fistulas associated in Crohn’s disease? A population-based study. Clin Gastroenterol Hepatol. 2006 Sep;4(9):1130–4.
15.
Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011 May;140(6):1785–94.
16.
Jauregui-Amezaga A, Rimola J, Ordás I, Rodríguez S, Ramírez-Morros A, Gallego M, et al. Value of endoscopy and MRI for predicting intestinal surgery in patients with Crohn’s disease in the era of biologics. Gut. 2015 Sep;64(9):1397–402.
You do not currently have access to this content.