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

Abstract

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. 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. 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. 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.