Review article: investigation and management of internal fistulae in Crohn’s disease

Summary Background Crohn’s disease is an inflammatory, penetrating intestinal associated with fistula formation. Fistulae in can be classified into external and internal fistulae. Internal fistulae form between the gastrointestinal tract another organ include enteroenteric, enterocolic, enterovesical rectovaginal They are significant morbidity a decreased quality of life. Aim To review classification, diagnosis, medical surgical management disease, propose treatment algorithm. Methods A literature on adult population was undertaken, synthesised summarised. Results occur up to 15% patients disease. Multi‐modal assessment including combination endoscopy cross‐sectional imaging, usually magnetic resonance, required diagnose determine extent Determining optimal strategies for these complex remains challenge due limited generally low‐quality data. Most studies date have focussed luminal (usually post hoc) outcomes more often reported fistulae, particularly perianal than Anti‐tumour necrosis factor therapies emerged as mainstay therapy, promising data but many will still require intervention. The indications timing surgery vs therapy uncertain; thus multi‐disciplinary input when making such decisions important. Conclusions result significantly increased further multi‐modality incorporating required.