Octreotide as a bridge to Anti-TNF therapy in severe fistulizing Crohn’s disease complicated by a clinically high-output enterocutaneous fistula: A case report and literature review

Authors

• Btissam Essadi (LAPOD) Research Laboratory of Pathology and Digestive Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco; Department of Hepato-Gastroenterology, Mohammed VI University Hospital Center, Oujda, Morocco
• Mouhssine Benderrou (LAPOD) Research Laboratory of Pathology and Digestive Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco; Department of Hepato-Gastroenterology, Mohammed VI University Hospital Center, Oujda, Morocco
• Ouiam Elmqaddem (LAPOD) Research Laboratory of Pathology and Digestive Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco; Department of Hepato-Gastroenterology, Mohammed VI University Hospital Center, Oujda, Morocco
• Hajar Koulali (LAPOD) Research Laboratory of Pathology and Digestive Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco; Department of Hepato-Gastroenterology, Mohammed VI University Hospital Center, Oujda, Morocco
• Abdelkrim Zazour (LAPOD) Research Laboratory of Pathology and Digestive Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco; Department of Hepato-Gastroenterology, Mohammed VI University Hospital Center, Oujda, Morocco
• Zahi Ismaili (LAPOD) Research Laboratory of Pathology and Digestive Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco; Department of Hepato-Gastroenterology, Mohammed VI University Hospital Center, Oujda, Morocco
• Ghizlane Kharrasse (LAPOD) Research Laboratory of Pathology and Digestive Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco; Department of Hepato-Gastroenterology, Mohammed VI University Hospital Center, Oujda, Morocco

btissamfg.1995@gmail.com

Keywords

Abstract

Introduction: Fistulizing Crohn’s disease is a severe phenotype of inflammatory bowel disease and may be complicated by enterocutaneous fistulas, which are associated with substantial morbidity due to sepsis, fluid and electrolyte disturbances, skin damage, and severe malnutrition. Anti-tumour necrosis factor agents, particularly infliximab, represent a cornerstone of medical therapy for fistulizing Crohn’s disease. However, their initiation may need to be temporarily deferred in patients with septic risk, uncontrolled fistula output, or profound nutritional impairment.
Case report: We report the case of a 54-year-old man with severe stenosing and fistulizing ileocolonic Crohn’s disease, classified as A3L3B3P0 according to the Montreal classification, complicated by a long-standing -clinically high-output- enterocutaneous fistula. On admission, he had severe malnutrition, with a body mass index of 13.8 kg/m², hypoalbuminemia at 24 g/L, hyponatremia, elevated C-reactive protein, and multiple complex fistulous tracts on abdominopelvic computed tomography, without a drainable deep collection.
Because immediate infliximab therapy was considered unsafe, a multidisciplinary -bridging strategy- was initiated, combining nutritional optimization, local wound care, correction of deficiencies, and subcutaneous octreotide at a dose of 100 µg every 8 hours for one month. This approach was associated with a marked reduction in fistula output, from six to seven pouch changes per day to one daily change, progressive improvement of skin lesions, weight gain without edema, increased serum albumin, and decreased systemic inflammation. These improvements allowed subsequent initiation of infliximab therapy.
Conclusion: This case suggests that octreotide may be useful as -adjunctive antisecretory bridge therapy- in selected patients with Crohn’s disease-associated clinically high-output enterocutaneous fistulas when biologic therapy must be delayed. Its role should not be interpreted as definitive fistula therapy, but rather as part of a broader strategy aimed at reducing fistula output, improving nutritional and inflammatory status, and creating safer conditions for disease-modifying treatment.

References