Une fistule rectovésicale révélatrice d’une maladie de Crohn

Abstract

Crohn's disease is responsible for 20% of uroenteric fistulas and is the first aetiology of colovesical fistula in young patients. The authors report an unusual case of rectovesical fistula and discuss diagnosis and treatment of Crohn's urodigestive fistulas. A young patient, 38 years old, non smoker, was operated of a suspected bladder tumor by a transuretral approach. Postoperatively appeared a pneumaturia, later on related to a rectovesical fistula. Histology was unclear reporting inflammatory pseudotumor of the bladder. A laparotomy was then performed as the patient was in incomplete bowel occlusion. Peroperative findings and pathological analysis were in favor of a Crohn's disease which was confirmed by secondary study of pathology samples. Resection of terminal ileum and cure of rectovesical fistula protected by a colostomy were performed. The patient completely recovered with an adjuvant medical treatment by infliximab (Remicade). The authors discuss diagnosis management of a pneumaturia and the occurrence of various Crohn's disease related urodigestive fistulas. A review of recently published papers emphasises the interest of using monoclonal antibodies in the medical treatment of Crohn's fistulas after discarding abdominal tuberculosis. In every cases anyway, surgery remains indicated when diagnosis work up reveals presence of an abscess or a bowel stenosis. Crohn's disease should be evocated when histology is not relevant in front of a bladder pseudotumor or a rectovesical fistula.