Enterovesical fistulas in Crohn disease

Area of Science:

• Gastroenterology
• Urology
• Surgical Science

Background:

• Enterovesical fistulas are uncommon complications of Crohn disease.
• Only 2% of Crohn disease patients develop bladder symptoms.
• Symptoms often include pneumaturia and fecaluria, but diagnosis can be challenging.

Purpose of the Study:

• To describe the clinical presentation and surgical management of enterovesical fistulas in Crohn disease patients.
• To highlight the diagnostic utility of cystoscopy when radiographic methods fail.

Main Methods:

• Retrospective review of five patients with Crohn disease and enterovesical fistulas.
• Surgical intervention included small-bowel resection, fistula excision, partial bladder resection, and diverting ileostomy.
• Ileostomy closure was performed as a second stage.

Main Results:

• Five patients (mean age 30) presented with prolonged bowel disease and short-term urinary symptoms.
• Pneumaturia and fecaluria were present in three patients.
• Radiography failed to demonstrate fistulas; cystoscopy successfully identified the fistula and bladder inflammation.

Conclusions:

• Enterovesical fistulas in Crohn disease require surgical intervention.
• Cystoscopy is a valuable diagnostic tool for identifying fistulas when imaging is inconclusive.
• A staged surgical approach involving resection and diversion followed by closure is effective.