Gastrointestinal Internal Fistulas in Crohn's Disease

A 27-year-old man with fistulizing terminal ileal Crohn's disease with an ileosigmoid fistula progressed through medical management and required an abdominal operation at an outside hospital. He underwent an ileocolic resection and a debridement with oversewing of his mesenteric sigmoid fistula with a diverting loop ileostomy. After a normal colonoscopy, his stoma was reversed; however, 2 weeks later he presented to the hospital with pelvic sepsis. A CT scan with oral, intravenous, and rectal contrast demonstrated a persistent sigmoid fistula with associated abscess. After treatment with antibiotics and percutaneous drainage, the patient underwent a segmental sigmoid resection to repair the mesenteric fistula and a diverting loop ileostomy. The ileostomy has been reversed and the patient's Crohn's disease is in remission.