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Enterovesical fistulas in Crohn's disease
F Heyen1, N S Ambrose, R N Allan
1Department of Gastroenterology, General Hospital, Birmingham.
Annals of the Royal College of Surgeons of England
|March 1, 1989
Summary
Enterovesical fistulas complicate Crohn's disease in 2.4% of patients. Surgical resection is recommended for persistent symptomatic fistulas, with bladder defect closure and catheterization for optimal healing.
Area of Science:
- Gastroenterology
- Urology
- Surgical Oncology
Background:
- Enterovesical fistulas are a known complication of Crohn's disease.
- These fistulas can significantly impact patient quality of life and present with diverse symptoms.
Purpose of the Study:
- To analyze the incidence, presentation, and management outcomes of enterovesical fistulas in Crohn's disease patients.
- To evaluate the effectiveness of different treatment strategies, including conservative management and surgical intervention.
Main Methods:
- Retrospective review of 799 patients with Crohn's disease.
- Analysis of fistula origin, presenting symptoms, diagnostic methods, and treatment outcomes.
- Evaluation of conservative management, surgical resection, and bypass procedures.
Main Results:
- 19 enterovesical fistulas (2.4%) were identified, originating from the ileum, colon, or both.
- Only 13 patients had urinary symptoms; many fistulas were found incidentally.
- Surgical resection led to healing in 9 of 12 cases, with 2 recurrences. Conservative management showed uncertain outcomes. Bypass procedures resulted in mortality.
Conclusions:
- Persistent symptomatic enterovesical fistulas in Crohn's disease warrant surgical resection.
- Successful management involves bowel segment resection, primary anastomosis when feasible, and bladder defect closure with catheterization for confirmed healing.