Prise en charge de la maladie de Crohn fistulisante hors fistules ano-périnéales dans une population marocaine : à propos de 60 cas

Abstract

IntroductionCrohn’s disease is an inflammatory enterocolitis, witch may be complicated by enterocutaneous, intestinal, entero-vesical and recto-vaginal fistulas.Materials and methodsThis is a retrospective study of 60 cases of fistulizing Crohn’s disease followed in the Department of Gastroenterology “B” at Ibn Sina Hospital in Rabat.ResultsOf a total of 245 cases of Crohn’s disease, 60 patients (24.5%) had a fistulizing form, excluding anoperineal fistulas. The location of fistulas was predominatly an intestinal fistulas (44%), followed by enterocutaneous fistulas (26%), enterovesical fistulas (10%) and recto-vaginal fistulas (7%). Medical treatment with immunosuppressors was prescribed in 15 cases of intestinal fistulas, 2 cases of enterocutaneous fistulas and 1 case of recto-vaginal fistula followed by a closure of fistula in 26% of the intestinal fistulas and treatment failure in the other locations. Surgical treatment was indicated immediately in 70% of the cases and after failure of medical treatment in 11.3% of the cases. Endoscopic recurrence was significantly more frequent in patients who postoperativelyreceived aminosalicylates (61.5%) compared to those treated with immunosuppressor (25%) (p <0.01). Clinical remission was also significantly associated with medical treatment with immunosuppressors (78.4%) compared with aminosalicylates (21.6%) (P = 0.04).ConclusionsSurgical treatment remains indicated in themajority of cases of fistulizing Crohn’s disease (70%). In our study, endoscopic recurrence and clinical remission were significantly associated with the type of medical treatment postoperatively.