The fistulising form of Crohn’s disease afflicts from 26 up to 50 % of patients during their life. Pain in the perianal region is frequently a symptom of an abscess but it also might run asymptomatically. The condition of a successful management of fistulas is a correct diagnosis, which requires a careful clinical examination, endoscopy and magnetic resonance or endosonography of the rectum. The priority of the treatment is abscess drainage and antibiotic treatment which must not be delayed. The treatment of simple fistulas is usually conservative with a possible completion with surgical procedures. Complex fistulas are necessary to be treated with an intensive medicamentous therapy in combination with surgical techniques in centres for the treatment of inflammatory diseases of the intestine. The base for the medicamentous treatment is azathioprine and anti-TNF antibodies. The treatment of fistulising Crohn’s disease is a long-term one. Fistulas out of the perianal region are usually the domain of surgery, even if medicamentous treatment might be successful in some cases, or it might distinctly increase the speed of healing and subsequent natural development of Crohn’s disease.