Enterovesical fistula complicating Crohn's ileocolitis.

Area of Science:

• Gastroenterology
• Urology
• Surgical Oncology

Background:

• Enterovesical fistula is an infrequent yet difficult surgical complication of Crohn's ileocolitis.
• Patients often have a history of medical management and prior bowel resections for Crohn's disease.
• Fistula onset frequently coincides with Crohn's disease exacerbation, presenting with dysuria or fecaluria.

Purpose of the Study:

• To evaluate the surgical management and outcomes of enterovesical fistulas in Crohn's disease patients.
• To highlight the diagnostic challenges and treatment strategies for this complex condition.

Main Methods:

• Retrospective analysis of 29 patients with enterovesical fistulas secondary to Crohn's ileocolitis.
• Surgical intervention involved ileocecal resection with primary anastomosis or exteriorization.
• Bladder defect management included excision and closure with absorbable sutures.

Main Results:

• Radiographic evaluation had limited diagnostic utility for fistula presence.
• Cystoscopy was suggestive in 18 of 20 examined patients.
• Surgical treatment resulted in uneventful recovery for most patients, with one developing a self-resolving bladder leak.

Conclusions:

• Ileovesical fistula is a clear indication for surgical intervention to resolve urinary sepsis and associated Crohn's complications.
• Successful management requires an individualized approach to the underlying intestinal disease, while bladder defect repair is routine.
• Prompt surgical treatment can effectively manage urinary sepsis and improve outcomes in Crohn's patients with enterovesical fistulas.