Pseudo-lleovesical Fistula in Crohn Disease

Abstract

INTERNAL and external fistulae often occur during the course of Crohn disease^1-3and occasionally are the initial manifestations of this disorder.⁴ We wish to report a patient with an apparent ileovesical fistula on barium enema that was subsequently shown to be an atypical manifestation of partial small-bowel obstruction. <h3>Report of a Case</h3> This 26-year-old white man had had intermittent watery diarrhea for about six years. A rectal fistula had been surgically corrected five years previously but had healed poorly. Two weeks before admission, he had noted the sudden onset of crampy lower abdominal pain, diarrhea, and intermittent vomiting that was relieved at first by defecation. A barium enema, which was interpreted as showing an ileovesical fistula and an incomplete small-bowel obstruction (Fig 1), prompted his referral for further evaluation and therapy. Physical examination revealed a thin, chronically ill-appearing young man in no acute distress. Abdominal examination showed moderate