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Fistelnder und abszedierender Morbus Crohn

Wann welche Strategie?

Fistulas and abscesses in Crohn’s disease

Which strategy when?

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  • Published:
Der Gastroenterologe Aims and scope

An Erratum to this article was published on 25 October 2009

Zusammenfassung

Der abszedierende und fistulierende Morbus Crohn sollte grundsätzlich interdisziplinär behandelt werden. Abszesse müssen prinzipiell drainiert werden, eine absolute Operationsindikation besteht bei enterovesikalen, blind endenden retroperitonealen und hohen enterokutanen bzw. interenterischen Fisteln mit Kurzdarmsyndrom. Perianale Fisteln stellen eine relative Operationsindikation dar, wobei das operative Vorgehen vom Fisteltyp (einfach oder komplex) und der Lokalisation abhängt. Immunsuppressiva stellen heutzutage eine Standardtherapie bei Morbus Crohn dar. Die Anti-TNF-Antikörper haben die Therapieoptionen, vor allem beim perianalen Befall, erweitert. Selbstverständlich ist bei jedem dieser Patienten nicht nur eine enge Abstimmung zwischen dem behandelnden Chirurgen und Internisten, sondern auch eine auf die jeweilige Situation zugeschnittene Therapie erforderlich. Der interdisziplinäre Ansatz ist auch deswegen so wichtig, weil aufgrund der heterogenen Präsentation vor allem des perianalen Fistelleidens und der dadurch erschwerten Klassifikation nur unzureichend vergleichbare Daten aus prospektiven Studien vorliegen.

Abstract

Patients with fistulizing Crohn’s disease or abscesses should generally be treated using an interdisciplinary approach. Abscesses principally warrant drainage. There is an absolute indication for surgery in enterovesical, blind-ending retroperitoneal and high enterocutaneous or interenteric fistulas with a short bowel syndrome. Perianal fistulas are a relative indication for surgery, the surgical approach being dependent on the type (simple or complex) and location of the fistula. Immunosuppressives nowadays are standard therapy in Crohn’s disease. Anti-TNF antibodies have improved the therapeutic options, especially in perianal disease. Each patient with fistulas or abscesses in Crohn’s disease requires not only close cooperation between the treating surgeon and the internist/gastroenterologist but also a therapy tailored to his or her specific situation. Because of the heterogeneous presentation (especially in perianal disease) and difficult classification, only inadequate comparative data are available from prospective studies, making an interdisciplinary approach even more important.

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  1. Chirurgische Universitätsklinik, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland

    P. Kienle & E. Stange

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  1. P. Kienle
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  2. E. Stange
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Correspondence to P. Kienle.

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An erratum to this article can be found online at http://dx.doi.org/10.1007/s11377-009-0356-5

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Kienle, P., Stange, E. Fistelnder und abszedierender Morbus Crohn. Gastroenterologe 4, 427–436 (2009). https://doi.org/10.1007/s11377-009-0294-2

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