Ileovesical fistulas in Crohn's disease: Clinical features and therapeutic manipulations in 5 patients

Abstract

The aim of this study was to describe the clinical details, and
diagnostic and therapeutic manipulations applied on 5 patients
with Crohn's disease who developed enterovesicular fistulas
during the course of the underlying inflammatory bowel
disease. These patients represent a percentage of 2.4% (5 out
of 206) of patients with Crohn's disease seen and followed-up
in our institution during the last fifteen years. There were 3
men and 2 women aged 34, 22, 32, 46 and 49 years, respectively.
Small bowel was affected in 4 and concurrently the small
and large bowel in 1 patient. During diagnosis of enterovesicular
fistula, Crohn's disease was active in all cases. Main
symptoms included pneumaturia, fecalurea, fever, urgency,
and abdominal pain. Colonoscopy did not offer significant
diagnostic aid. Abdominal computed tomography and barium
enema helped in one case. Cystoscopy revealed a picture
compatible with cystitis in all cases and a protruding mass in
one. In one case the administration of Infliximab, the chimeric
antibody against tumor necrosis alpha, resulted in temporary
improvement. The administration of suitable antibiotics
resulted in temporary disappearance of E. coli strains from
urine in all cases. All patients were finally operated on. The
surgical procedure applied was detachment of the inflamed
bowel loop from urinary bladder and surgical closure of the
fistula in all patients, drainage of the accompanied abscess
in one case and partial enterectomy with end-to-end anastomosis
in two cases. It is concluded that enterovesicular fistulas
are a potentially dangerous complication of Crohn's disease,
requiring surgical treatment.
Key words: Crohn's disease, fistulas, urinary complications,
enterovesical fistulas