Chinese experts consensus on diagnosis and treatment of non-perianal fistulating Crohn disease / 中华胃肠外科杂志

ABSTRACT

Crohn disease (CD) is a chronic inflammatory disease involving the entire digestive tract and non-perianal fistula is the most serious surgical complication of CD. The goal of treatment is to cure intestinal fistula and intra-abdominal infection, restore the continuity of digestive tract, reduce postoperative recurrence, and improve the quality of life. Evaluation of nutritional status, especially during perioperative period, is important and nutrition support for malnutritional CD patients is necessary. Full assessment of non-perianal fistula and promotion of self-healing is the principal treatment, and surgical drainage combined with enteral nutrition may be a feasible treatment. Trocar puncture with sump drain is recommended to control intra-abdominal abscess. Surgical treatment of enterocutaneous fistula, enteroenteric fistula, enterovesical fistula or enterogynaecological fistula should be considered if medical treatment, nutrition support and surgical drainage fail. Laparoscopic surgery is recommended for patients with mild adhesion of non-perianal fistulating CD. Postoperative medical treatment and risk assessment should be carried out to reduce postoperative recurrence of CD and fistula.