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P270 Clinical and radiologic characteristics of intra-abdominal fistulising Crohn's disease

A. Benson*1, E. Aviran1, S. Yaari1, N. Lev Cohain1, J. Sosna1, R. Oren1, E. Israeli1

1Hadassah University Medical Center, Jerusalem, Israel

Background

Few studies describe the radiographic and laboratory characteristics of patients with Crohn’s disease (CD) with intra-abdominal fistulae. We therefore aimed to describe a cohort of CD patients with intra-abdominal fistulae and determine characteristics associated with complex fistulae.

Methods

Data were gathered retrospectively from the medical records and imaging studies of CD patients. Once patients with fistulae were identified, the radiographic studies were re-read by abdominal radiologists. The review included evaluation of the type of fistula, number of fistulae, and radiological characteristics. Clinical and imaging study characteristics were then compared between groups of patients with fistulae.

Results

Among 1233 patients with CD, a total of 205 fistulae in 132 patients were identified with an average patient age of 31 (±12) years. The average time from CD diagnosis to fistula development was 7 years. The most common type of fistula was entero-enteric (53%). Most CD patients in our cohort with an intra-abdominal fistula had only one fistula (54%), while patients with an extra-intestinal fistula presented with an average of 1.96 fistulae, compared with an average of 1.28 fistulae for those with a fistula limited to the bowel (p = 0.01). Aside from the number of fistula, no other significant differences were observed in radiological characteristics of patients who were diagnosed with a fistula at the time of CD diagnosis when compared with those diagnosed with a fistula subsequent to CD diagnosis. C-reactive protein (CRP) levels were above the upper limit of normal at time of fistula diagnosis in 66% of patients and albumin levels were below the lower limit of normal in 41% of patients.

Conclusion

This study reports data of a relatively large cohort of CD patients with intra-abdominal fistulae and may be used to help predict the course of fistulising CD. The most common CD-associated intra-abdominal fistulae are entero-enteric and entero-colonic fistulae. An extra-intestinal fistula and diagnosis of a fistula subsequent to diagnosis of CD were associated with an increased number of fistulae per patient, but were not associated with the development of fistula associated stenosis or abscess.