Surgical management of ileosigmoid fistulas in Crohn's disease

Seventeen patients with ileosigmoid fistula complicating Crohn's disease are reported on. Eighty-two percent of the fistulas were diagnosed radiologically. Thirteen of the patients (76 percent) were treated by resection of the diseased ileum and cecum with primary anastomosis, division of the fistula, and simple closure of the colon. There were no anastomotic leaks, and long-term follow-up demonstrated excellent results. Segmental sigmoid resection in addition to resection of the diseased ileum and cecum should only be performed when there is radiologic or histologic evidence of Crohn's disease of the colon. Proximal diversion is generally not required, and most procedures can be performed in one stage.