Extract

To the Editor:

The efficacy of tumor necrosis factor alpha (TNF-α) inhibitors in treating perianal fistulas in Crohn's disease (CD) have been widely demonstrated. Less convincing are the data on the treatment of enterocutaneous or internal fistulas, like enterovescical or rectovaginal fistulas. In a study including 26 patients with various types if fistulas 54% needed surgery despite therapy with infliximab (IFX). None of the enterocutaneous or peristomal fistulas responded to biologic therapy.1 Another report on four cases employing IFX reported success only for perianal fistulas but not for internal ones.2 For complex perianal fistulas a combined approach, medical and surgical, using evaluation under anesthesia, seton placement, and abscess drainage is now widely employed with satisfying results,3 but no data are available on enterocutaneous fistulas that frequently are complicated by early postoperative complications. We describe here the cases of three patients with fistulizing CD treated successfully with a combination therapy of biologics and surgery.

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