Fistulas of the bladder in Crohn's disease

Fourteen patients with fistulas of the bladder complicating Crohn's disease are reported. In one-half of the patients, the presence of Crohn's disease was known before; in the other one-half, the appearance of urinary symptoms led to the diagnosis of Crohn's disease. The symptom most commonly encountered was chronic pyuria, while pneumaturia as an early sign was found in only three patients. Cystoscopy proved to be the most useful diagnostic procedure. The results of this examination demonstrated lesions in 11 of 13 patients investigated and was instrumental in arriving at the correct diagnosis in four patients. Treatment should be surgical and consist of intestinal resection and suturing of the usually small defect in the bladder. The results of the operation are good with respect to the complication of the urinary tract.