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The Respective Role of Medical and Surgical Therapy for Enterovesical Fistula in Crohn’s Disease

Zhang, Wei MD; Zhu, Weiming MD; Li, Yi MD; Zuo, Lugen MD; Wang, Honggang MD; Li, Ning MD; Li, Jieshou MD

Journal of Clinical Gastroenterology: September 2014 - Volume 48 - Issue 8 - p 708–711
doi: 10.1097/MCG.0000000000000040
ALIMENTARY TRACT: Original Articles

Goals and Background: There are very few reports available on the role of medical and surgical therapy for enterovesical fistula (EVF) in Crohn’s disease (CD). The goal of this study was to investigate the respective role of medical and surgical therapy.

Materials and Methods: Thirty-seven patients with EVF in CD, who were consecutively admitted to our institution between 2004 and 2011, underwent initial medical treatment. Medical records were abstracted from our prospective CD database. We performed a univariate analysis of risk factors for surgery.

Results: The origin of EVF was ileal (ileovesical fistula, 78.4%) and sigmoidal (sigmoidovesical and ileosigmoidovesical fistula, 21.6%). After medical therapy (antibiotics, azathioprine, steroids, infliximab, or a combination), 13/37 (35.1%) patients achieved long-term remission over a mean period of 4.7 years and avoided surgery. Surgery was performed in 24/37 (64.9%) patients presenting with intractable disease. Univariate analysis showed that the significant risk factors for surgery included sigmoid-originated EVF (P=0.019) and concurrent CD complications (P=0.001), such as small bowel obstruction, abscess formation, enterocutaneous fistula, enteroenteric fistula, and persistent ureteral obstruction or urinary tract infection.

Conclusions: For patients with ileovesical fistula alone, medical therapy is the first choice. For patients with ileovesical fistula accompanied by other CD complications, surgical intervention will most likely be needed. Patients with sigmoidovesical or ileosigmoidovesical fistula are more likely to require surgery than an uncomplicated ileovesical fistula.

Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, P.R. China

Supported by a grant from the Chinese National Ministry of Health for the Digestive Disease (grant 201002020).

The authors declare that they have nothing to disclose.

Reprints: Weiming Zhu, MD, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, P.R. China (e-mail: juwiming@163.com).

Received May 20, 2013

Accepted October 17, 2013

© 2014 by Lippincott Williams & Wilkins