Crohn's disease (CD) is a chronic, relapsing immune mediated disease, which is one of the two major types of inflammatory bowel disease (IBD). Fistulizing CD, pose a significant clinical challenge for physicians. Effective management of fistulizing CD requires a multidisciplinary approach, involving a gastroenterologist and a G.I surgeon, while tailoring treatment to each patient's unique risk factors, clinical representations, and preferences. This comprehensive review explores the intricacies of fistulizing CD including its manifestations, types, impact on quality of life, management strategies and novel therapies under investigation. Antibiotics are often used as first-line therapy to treat symptoms. Biologics that selectively target TNF-α, such infliximab (IFX), have shown high efficacy in randomized controlled trials. However, more than 50% of patients lose response to IFX, prompting them to explore alternative strategies. Current options include adalimumab and certolizumab pegol combination therapies, as well as small molecule drugs targeting Janus kinases such as Upadacitinib. Furthermore, a promising treatment for complex fistulas are mesenchymal stem cells such as Darvadstrocel (Alofisel) an allogeneic stem cell-based therapy. However, surgical interventions are necessary for complex cases or intra-abdominal complications. Setons and LIFT procedures are the most common surgical options.