INTESTINAL FISTULAS IN CROHNS DISEASE: A COMPLEX CHALLENGE - A MOROCCAN EXPERIENCE

Fistulizing Crohns disease represents a major therapeutic challenge for gastroenterologists due to its diagnostic complexity, high recurrence rate, and frequent need for surgery. This study aims to assess the epidemiological, radiological, evolutionary, and therapeutic profile of fistulizing Crohns disease, excluding ano-perineal lesions.Our study is a retrospective descriptive studyinvolving 70 patientsdiagnosed withfistulizing Crohns diseasein our department.Patients withisolatedano-perineal involvement were excludedfrom the study. Our results show an average age of 36 years and a male-to-female ratio of 1.4. The average disease duration was 7.27 years, with ileocolic involvement in 84.28% of cases. A stenosing phenotype was observed in 58.6% of patients. The most commun fistula types were entero-enteric (68.6%), followed by entero-colic (27.1%) and entero-cutaneous (21.4%). Radiological diagnosis was primarily made using abdominal CT (41.4%) and CT enterography (35.7%). Intra-abdominal abscesses were detected in 44.3% of patients.Regarding therapeutic management, immunosuppressive therapy was initiated in 30% of cases, combination therapy in 22.9%, primary surgery in 20%, biologic therapy in 14.3%, and surgery following medical treatment failure in 12.9%. Access to biotherapy remains limited among Moroccan patients due to financial constraints.Clinical remission was achieved in 81.4% of patients, while 15.7% experienced disease recurrence.