TITLE

Diagnosis and Management of Enterovesical Fistulas in Patients with Crohn's Disease

AUTHOR(S)
Gruner, Jeffrey S.; Sehon, J. Kenneth; Johnson, Lester W.
PUB. DATE
August 2002
SOURCE
American Surgeon;Aug2002, Vol. 68 Issue 8, p714
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
The objective of this study was to investigate the clinical manifestations and diagnostic studies used to evaluate Crohn's patients with enterovesical fistulas (EVFs) and to assess outcome after surgical intervention. This is a ten year multi-institutional retrospective chart review of patients with Crohn's disease. Of 400 patients identified with Crohn's disease eight (2%) were diagnosed with EVF. The mean age at diagnosis was 27 years. No patients had prior surgeries for Crohn's. Duration of symptoms ranged from 6 months to 15 years. There were seven ileovesical and one colovesical fistula identified. One patient had associated perianal disease. Three had concomitant enteroenteral fistulae. Clinical features included pneumaturia in seven patients (88%), fecaluria in three (38%), hematuria in five (63%), and urinary tract infection symptoms in seven (88%). Diagnostic studies included CT scan in six, barium or gastrografin enema in four, and cystoscopy in four. Surgical therapy involved resection of the affected bowel. The bladder defect was closed primarily in two layers in all patients using absorbable suture, with omental patch in four. Two patients underwent ileostomy and one underwent colostomy, all taken down within 6 months. There were no bladder leaks and no anastamotic leaks. There were no perioperative deaths. The mean postoperative stay was nine days. The mean follow-up was 39 months. We conclude that pneumaturia is a strong clinical indicator of EVF. CT has been valuable in identifying gas within the bladder in these patients. Cystoscopy has proven useful in identifying the fistulous tract and in evaluation of the ureters. The presence of an EVF should heighten suspicion as to the presence of concomitant enteroenteral fistulae. Barium or gastrografin studies are useful in this capacity. Surgical treatment of EVFs should include resection of affected bowel. The bladder defect can safely be closed using absorbable suture.
ACCESSION #
7743267

 

Related Articles

  • Pipe cleaner brush for “curettage” of perianal fistulas. Zmora, O.; Scott, D.; Khaikin, M.; Venturero, M.; Koller, M. // Techniques in Coloproctology;Aug2004, Vol. 8 Issue 2, p116 

    Investigates the use of pipe cleaner brush. Factors associated with chronic perianal fistula; Use of pepi cleaner brush in the treatment of perianal fistulas.

  • The sphincter preserving perianal fistulectomy: A better alternative. Mangual, R.N.; Tudu, D.N.; Pattnaik, S.P.; Mohanty, S.S.; Prusty, K.P. // Indian Journal of Surgery;Jan/Feb2004, Vol. 66 Issue 1, p31 

    A fistula-in-ano is not only a common problem associated in surgical practice, but also its patho-anatomy is poorly understood by many. In this series, over a period of 12 years, 120 cases were included in the study, explained the patho-anatomy, that all the perianal fistula are not fistula,...

  • Perineal skin bridge and levator muscle preservation in neutral sagittal anorectoplasty (NSARP) for vestibular fistula. Dave, S.; Shi, E. C. P. // Pediatric Surgery International;Sep2005, Vol. 21 Issue 9, p711 

    The incision in limited posterior sagittal anorectoplasty for vestibular fistula (VF) extends from the coccyx to the fistula with the rectum identified by partial sagittal division of the levator muscle. In anterior sagittal anorectoplasty, the perineal incision extends from the fistula opening...

  • Bilateral complete second branchial cleft fistula: case report and its embryological review. Motwani, Rohini; Sontakke, Yogesh; Swarnakar, Neha; Dada, Rima // Indian Journal of Medical Specialities;Jul-Dec2013, Vol. 4 Issue 2, p305 

    A 10 year male presented with small, bilateral openings in the lower part of front of neck since birth with complaints of intermittent mucoid discharge for last one year. On examination, bilateral openings along the anterior border at junction of middle and lower third of the sternocleidomastoid...

  • Low anorectal malformation in females without fistula: A rare entity. Upadhyaya, Vijay D.; Gangopadhyaya, A. N.; Pandey, Anand; Gupta, D. K.; Upadhyaya, Ashish // Internet Journal of Surgery;2007, Vol. 12 Issue 1, p6 

    Anorectal malformations (ARM) are one of the most common congenital defects. Male and female patients are equally affected. Low anorectal malformations are common in males as well in females. Most of the male low ARM present without fistula. Low ARM in female without any fistula is very rare. We...

  • A prospective randomized comparative study on the use of ventral subcutaneous flap to prevent fistulas in the Snodgrass repair for distal hypospadias. Savanelli, Antonio; Esposito, Ciro; Settimi, Alessandro // World Journal of Urology;Dec2007, Vol. 25 Issue 6, p641 

    We evaluated the importance of urethral coverage using vascularized subcutaneous ventral flaps for the prevention of fistulas in patients undergoing distal hypospadias repair. Our prospective study included 130 patients, aged 9 months to 12 years, who underwent distal hypospadias repair using...

  • Lymphatic fistula to the vagina. Mills, S. C.; Lee, J.; Marshall, M.; Cohen, R. // Journal of the Royal Society of Medicine;Aug2005, Vol. 98 Issue 8, p365 

    The article presents a case of lymphoceles and lymphatic fistulae which are rare complications of abdominal surgery. They have found out that an exploratory laparotomy revealed no cause for the discharge and a hysterectomy and bilateral salpingo-oophorectomy were undertaken. The management...

  • Hypospadias repair and glans augmentation using a modified Mathieu technique. Nezami, Behtash Ghazi; Mahboubi, Amir Hassan; Tanhaeivash, Roozbeh; Tourchi, Ali; Kajbafzadeh, Abdol Mohammad // Pediatric Surgery International;Mar2010, Vol. 26 Issue 3, p299 

    Purpose: To describe a modification in Mathieu (perimeatal-based flap urethroplasty) technique that incorporates glans augmentation into the procedure and is applicable for hypospadias patients with small glans and shallow urethral grooves.Patients and Methods:...

  • Arterial-esophageal fistula: a severe complication in children with cardiovascular abnormalities. Fuentes, Sara; Cano, Indalecio; López, María; Moreno, Cecilia; Tejedor, Raquel; Marianeschi, Stefano; García, Enrique; Gómez, Andrés; López, María; García, Enrique; Gómez, Andrés // Pediatric Surgery International;Mar2010, Vol. 26 Issue 3, p335 

    Fistulae between esophagus and major arteries are an extremely rare and severe condition. They have been described in patients with previous impairment or abnormalities of mediastinal vessels and intraesophageal increased pressure or as a complication of cardiovascular procedures. We report...

  • Gastrostomy Tube Insertion into Intestinal-Cutaneous Tract Fistulas Is a New Technique to Improve Fistula Control. J. Halttunen; J. Sirén; E. Kivilaakso // Digestive Surgery;2003, Vol. 20 Issue 6, p516 

    Background: The management of gastrointestinal-cutaneous fistulas may be complicated by the difficulty in obtaining adequate control of the fistula tract. This study describes a new method to obtain better fistula control utilizing a semi-rigid stent in the form of a gastrostomy tube. Methods:...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics