Enterovesical fistula complicating Crohn's ileocolitis

An enterovesical fistula, an infrequent complication of Crohn's ileocolitis which is considered to constitute a difficult surgical problem, was encountered in 29 patients. These patients had been treated for Crohn's disease by medical means for years and several had previously undergone bowel resections. An exacerbation of the Crohn's disease occurred in all patients coincident with the appearance of dysuria or the obvious clinical presentation (fecaluria) of the fistula. Other manifestations of active Crohn's disease frequently coexisted. Radiographic evaluation was of limited help in establishing the presence of the fistula. Cystoscopy was suggestive of the diagnosis in 18 of 20 patients so examined. Treatment consisted of ileocecal resection with primary anastomosis (25) or exteriorization (4). The bladder defect was sparingly excised and closed with absorbable sutures. One patient developed a bladder leak which closed spontaneously. Recovery was uneventful in the others. An ileovesical fistula constitutes an indication for operation not only to eradicate the urinary sepsis but also to correct the other complications (malnutrition, obstruction, abscess) of Crohn's disease. To assure an uncomplicated course, emphasis must be placed on an individually designed correct approach to the (causative) intestinal problem, while the surgical aspects of the bladder defect can be a matter of routine.