Surgical management of ileosigmoid fistula in Crohn's disease

Seventeen cases with Crohn's disease and ileosigmoid fistula were reviewed. They have been subdivided into four groups according to the anatomic site and extent of disease. Seven patients had disease localized to the terminal ileum and a fistula to normal sigmoid. Five were treated by ileocolic resection and simple of the sigmoid fistula (group I. All seven cases with concomitant sigmoid involvement had a double resection (group II). Two patients with diffuse ileocolitis (group III) had subtotal colectomy and ileostomy. One case (group IV) had left-sided colonic disease with a fistula to normal ileum and was treated with a double resection. In six patients, a temporary ileostomy was performed to protect the anastomoses. Forty-seven percent of patients had granulomatous involvement at only one end of the fistula. Resection of the diseases bowel and simple closure of the fistula can be performed safely in most patients in this group.