Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1993 Nov;218(5):660–666. doi: 10.1097/00000658-199321850-00012

Incidence, diagnosis, and treatment of enteric and colorectal fistulae in patients with Crohn's disease.

F Michelassi 1, M Stella 1, T Balestracci 1, F Giuliante 1, P Marogna 1, G E Block 1
PMCID: PMC1243038  PMID: 8239781

Abstract

OBJECTIVE: The authors review their experience, evaluating the incidence and examining the various modalities employed in the diagnosis and treatment of patients with Crohn's disease complicated by fistulae. SUMMARY BACKGROUND DATA: Although common, internal and external fistulae in Crohn's disease may pose challenging problems to the surgeon. METHODS: Of 639 patients who underwent surgical treatment at the University of Chicago between 1970 and 1988 for complications of Crohn's disease, 222 patients (34.7%) were found to have 290 intra-abdominal fistulae. RESULTS: A fistula was diagnosed preoperatively in 154 patients (69.4%), intraoperatively in 60 (27%), and only after examination of the specimen in 8 (3.6%). The fistula represented the primary or single indication for surgical treatment in 14 patients (6.3%) and one of several indications in the remaining patients. Of 165 patients with an abdominal mass or abscess, 69 (41.8%) had a fistula. All patients underwent resection of the diseased intestinal segment; 160 (73.1%) with primary anastomosis and the remaining 62 with a temporary or permanent stoma. The fistula was directly responsible for a stoma in only 16 patients (7.2%) and was never responsible for a permanent stoma. Resection of the diseased bowel achieved en bloc removal of the fistula in 145 cases. Removal of 93 additional fistulae required resection of the diseased bowel segment along with closure of a fistulous opening on the stomach or duodenum (n = 14), bladder (n = 35), or rectosigmoid (n = 44). When the fistula drained through a vaginal cuff (n = 4), the opening was left to close by secondary intention; when the fistula opened through the abdominal wall (n = 46), the fistulous tract was debrided. In the remaining two entero-salpingeal fistulae, en bloc resection of the involved salpinx accomplished complete removal of the fistula. There was a dehiscence of one duodenal and one bladder repair; 14 patients (6%) experienced postoperative septic complications and one patient died. CONCLUSIONS: Fistulae are diagnosed preoperatively in 69% of cases and can be suspected in as many as 42% of patients with an abdominal mass. Fistulae are the primary or single indication for surgical treatment and are directly responsible for a stoma only in a few patients. Treatment, based on resection of the diseased bowel and extirpation of the fistula, can be accomplished with minimal morbidity and mortality.

Full text

PDF
660

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Fazio V. W., Wilk P., Turnbull R. B., Jr, Jagelman D. G. The dilemma of Crohn's disease: ileosigmoidal fistula complicating Crohn's disease. Dis Colon Rectum. 1977 Jul-Aug;20(5):381–386. doi: 10.1007/BF02587365. [DOI] [PubMed] [Google Scholar]
  2. Fitzgibbons T. J., Green G., Silberman H., Eliasoph J., Halls J. M., Yellin A. E. Management of Crohn's disease involving the duodenum, including duodenal cutaneous fistula. Arch Surg. 1980 Sep;115(9):1022–1028. doi: 10.1001/archsurg.1980.01380090006003. [DOI] [PubMed] [Google Scholar]
  3. Glass R. E., Ritchie J. K., Lennard-Jones J. E., Hawley P. R., Todd I. P. Internal fistulas in Crohn's disease. Dis Colon Rectum. 1985 Aug;28(8):557–561. doi: 10.1007/BF02554140. [DOI] [PubMed] [Google Scholar]
  4. Greenstein A. J., Kark A. E., Dreiling D. A. Crohn's disease of the colon. I. Fistula in Crohn's disease of the colon, classification presenting features and management in 63 patients. Am J Gastroenterol. 1974 Nov;62(5):419–429. [PubMed] [Google Scholar]
  5. Heyen F., Winslet M. C., Andrews H., Alexander-Williams J., Keighley M. R. Vaginal fistulas in Crohn's disease. Dis Colon Rectum. 1989 May;32(5):379–383. doi: 10.1007/BF02563688. [DOI] [PubMed] [Google Scholar]
  6. Kyle J., Murray C. M. Ileovesical fistula in Crohn's disease. Surgery. 1969 Sep;66(3):497–501. [PubMed] [Google Scholar]
  7. Lee K. K., Schraut W. H. Diagnosis and treatment of duodenoenteric fistulas complicating Crohn's disease. Arch Surg. 1989 Jun;124(6):712–715. doi: 10.1001/archsurg.1989.01410060082017. [DOI] [PubMed] [Google Scholar]
  8. Mathews J. E., Peterson R. F., Eberts J. P., White R. R. Transmural disease of the alimentary tract. Ann Surg. 1971 Jun;173(6):966–970. doi: 10.1097/00000658-197106010-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Mekhjian H. S., Switz D. M., Melnyk C. S., Rankin G. B., Brooks R. K. Clinical features and natural history of Crohn's disease. Gastroenterology. 1979 Oct;77(4 Pt 2):898–906. [PubMed] [Google Scholar]
  10. Michelassi F., Balestracci T., Chappell R., Block G. E. Primary and recurrent Crohn's disease. Experience with 1379 patients. Ann Surg. 1991 Sep;214(3):230–240. doi: 10.1097/00000658-199109000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Pettit S. H., Irving M. H. The operative management of fistulous Crohn's disease. Surg Gynecol Obstet. 1988 Sep;167(3):223–228. [PubMed] [Google Scholar]
  12. Spirt M., Sachar D. B., Greenstein A. J. Symptomatic differentiation of duodenal from gastric fistulas in Crohn's disease. Am J Gastroenterol. 1990 Apr;85(4):455–458. [PubMed] [Google Scholar]
  13. Steinberg D. M., Cooke W. T., Alexander-Williams J. Abscess and fistulae in Crohn's disease. Gut. 1973 Nov;14(11):865–869. doi: 10.1136/gut.14.11.865. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Talamini M. A., Broe P. J., Cameron J. L. Urinary fistulas in Crohn's disease. Surg Gynecol Obstet. 1982 Apr;154(4):553–556. [PubMed] [Google Scholar]
  15. Wilk P. J., Fazio V., Turnbull R. B., Jr The dilemma of Crohn's disease: ileoduodenal fistula complicating Crohn's disease. Dis Colon Rectum. 1977 Jul-Aug;20(5):387–392. doi: 10.1007/BF02587367. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES