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Internal fistulas in Crohn's disease
Diseases of the Colon and Rectum
|August 1, 1985
Summary
For Crohn's disease internal fistulas, immediate surgery is not always necessary. Symptom severity, not just fistula presence, should guide treatment decisions for better patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease
Background:
- Crohn's disease frequently causes internal fistulas, posing treatment dilemmas.
- The optimal timing for surgical intervention in these cases remains debated.
- Previous approaches often advocated immediate surgery for all internal fistulas.
Purpose of the Study:
- To evaluate the outcomes of immediate versus delayed surgical intervention for internal fistulas in Crohn's disease.
- To assess the necessity of immediate surgery, particularly for fistulas involving the bladder.
Main Methods:
- Retrospective review of 59 patients with 83 internal fistulas treated between 1971 and 1982.
- Categorization of fistulas by origin (small intestine, large bowel) and involvement (bladder).
- Comparison of outcomes between patients undergoing immediate surgery, delayed surgery, and non-operative management.
Main Results:
- Of 59 patients, 36 had immediate surgery, 15 required later surgery, and 8 were managed non-operatively.
- Surgical treatment resulted in one postoperative death and 46 patients remaining well.
- Non-operative management for nine fistulas (four involving the bladder) led to good outcomes in seven patients.
Conclusions:
- Internal fistulas in Crohn's disease, including those involving the bladder, do not mandate immediate surgery.
- Treatment policy should be individualized based on clinical presentation and symptom severity.
- Conservative management can be effective for select patients with internal fistulas.
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