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

Management of fistulizing Crohn’s disease, excluding anoperineal fistulas, in a Moroccan population: about 60 cases

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Journal Africain d'Hépato-Gastroentérologie

Résumé

Introduction

La maladie de Crohn est une entérocolite inflammatoire, qui peut se compliquer de fistules entéro-cutanées, intestinales, entéro-vésicales et rectovaginales.

Matériels et méthodes

Il s’agit d’une étude rétrospective portant sur 60 cas de maladie de Crohn fistulisante suivis dans le service d’hépato-gastroentérologie « B » au CHU Ibn Sina de Rabat.

Résultats

Sur un total de 245 cas de maladie de Crohn, 60 patients présentaient une forme fistulisante, hors fistules ano-périnéales, soit un taux de 24,5%. La localisation des fistules était dominée par les fistules intestinales (44%), suivie des fistules entéro-cutanées (26%), puis des fistules entéro-vésicales (10%) et des fistules recto-vaginales (7%). Le traitement médical par les immunosuppresseurs a été instauré dans 15 cas de fistules intestinales, 2 cas de fistules entéro-cutanées et 1 cas de fistules recto-vésicales avec une fermeture des fistules dans 26% des fistules intestinales et un échec thérapeutique dans les autres localisations. Le traitement chirurgical était indiqué d’emblée dans 70% des cas et après échec du traitement médical dans 11,3% des cas. La récidive endoscopique était significativement plus fréquente chez les patients opérés traités, en post-opératoire, par les aminosalicylés (61,5%) par rapport à ceux traités par des immunosuppresseurs (25%) (p<0,01). La rémission clinique était également significativement associée au traitement médical par les immunosuppresseurs (78,4%) par rapport aux aminosalicylés (21,6%) (P=0,04).

Conclusions

Le traitement chirurgical reste indiqué dans la majorité des cas de la maladie de Crohn fistulisante (70%). Dans notre étude, la récidive endoscopique et la rémission clinique étaient significativement associées au type de traitement médical postopératoire.

Abstract

Introduction

Crohn’s disease is an inflammatory enterocolitis, witch may be complicated by enterocutaneous, intestinal, entero-vesical and recto-vaginal fistulas.

Materials and methods

This 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.

Results

Of 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).

Conclusions

Surgical 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.

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Authors and Affiliations

  1. Service d’hépatogastroentérologie « B », CHU Ibn Sina, Rabat, Maroc

    M. Fadlouallah, I. Errabih, H. Krami, N. Benzzoubeir, L. Ouazzani & H. Ouazzani

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  1. M. Fadlouallah
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  2. I. Errabih
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  3. H. Krami
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  4. N. Benzzoubeir
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  5. L. Ouazzani
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  6. H. Ouazzani
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Correspondence to M. Fadlouallah.

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Fadlouallah, M., Errabih, I., Krami, H. et al. Prise en charge de la maladie de Crohn fistulisante hors fistules ano-périnéales dans une population marocaine : à propos de 60 cas. J Afr Hepato Gastroenterol 8, 71–76 (2014). https://doi.org/10.1007/s12157-014-0522-3

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