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.

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/m 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. LEARNING POINTS: This case highlights the potential role of octreotide as adjunctive antisecretory bridge therapy in Crohn's disease-associated clinically high-output enterocutaneous fistulas when immediate biologic therapy is considered unsafe because of severe malnutrition, major inflammatory burden, or septic risk.This observation emphasizes the importance of multidisciplinary stabilization before biologic therapy, including nutritional optimization, correction of metabolic and electrolyte abnormalities, local wound care, and inflammatory control in fragile patients with complicated fistulizing Crohn's disease.This case demonstrates that a conservative strategy integrating octreotide may achieve substantial reduction in fistula output, improvement of nutritional and biological status, and creation of safer conditions for subsequent disease-modifying therapy initiation.