[Enterovesical fistulas in Crohn disease: diagnosis and treatment]

Abstract

Internal fistula is a complication of Crohn's disease. Among 589 patients operated upon at Hôpital Saint-Antoine between 1970 and 1992, 17 (2.9%) had entero-vesical fistula. Ileovesical fistulas were twice as frequent as sigmoidovesical fistulas. Typical symptoms were pneumaturia, fecaluria, and recurrent urinary tract infection. Cystoscopy was performed in 8 patients and determined the site of the fistula in each case. The indication for operation was the fistula itself (35%) or another complication of Crohn's disease (65%). Associated lesions were as follows: 6 entero-enteral, 2 ileogenital, 5 enterocutaneous fistulas and 6 intraabdominal abscesses. Resection of the bowel segment responsible for the fistula was performed in every case, with primary anastomosis in 9 cases and enterostomy in 8 cases. The vesical opening was excised and sutured in 10 cases and left open in 7 cases. An urethral catheter was left in place for at least 7 days. There was no postoperative death; one postoperative external vesical fistula healed without reoperation. Seven enterostomies have been closed, one is definitive. There were no late recurrences of vesical fistula.