[Intestinal fistula in Crohn disease]

The treatment of patients with Crohn's disease (CD) presenting intestinal fistulas is debated. A retrospective analysis was made of the treatment of 26 patients with Crohn's disease who had a total of 37 fistulas: 28 internal and 9 external. In 19 patients the fistulas were single and in 7 multiple; in most patients the fistula originated on the terminal ileum. Crohn's disease was ileal in 10 patients, ileocolonic in 15 and exclusively colonic in 1, and the evolution of the disease from the onset of symptoms to the appearance of the fistula was a mean of 5.8 years. The diagnosis, except for two patients in whom it was an operative finding, was based on the clinical examination and radiology studies. All the patients, except for four with asymptomatic internal fistulas, underwent medical treatment as needed. Six patients required only medical treatment, and the rest, 16, received medical and surgical treatment. Surgical treatment consisted basically of resection of the intestinal segment affected by the fistula, with or without anastomosis. The operative mortality was 0% and the morbidity was 25%, the most frequent complication being infection of the surgical wound. All the patients with external fistulas required surgical treatment. In every case the fistula was single. The treatment of internal fistulas in conditioned by the symptoms the response to medical treatment and the presence or not of associated pathology. Asymptomatic patients or those who responded to medical treatment had single fistulas.