How is enterovesical fistula due to Crohn disease treated?

Updated: Dec 24, 2020
  • Author: Joseph Basler, MD, PhD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
  • Print

For enterovesical fistulae due to Crohn disease, medical therapy is the first choice. [57] Zhang et al reported that 13 of 37 patients with Crohn disease achieved long-term remission of enterovesical fistulae over a mean of 4.7 years through treatment with antibiotics, azathioprine, steroids, and/or infliximab. Significant risk factors for surgery included sigmoid-originated fistulae and concurrent Crohn disease complications such as small bowel obstruction, abscess formation, enterocutaneous fistula, enteroenteric fistula, and persistent ureteral obstruction or urinary tract infection. [58]

In a study analyzing the outcomes of 97 patients with enterovesical fistulae due to Crohn disease, the use of anti-TNF agents was associated with an increased rate of remission without need for surgery (hazard ratio 0.23, 95% confidence interval 0.12–0.44; p < 0.001). [59]  A review of Crohn disease–related internal fistulae, including 16 enterovesical fistulae, treated with anti-TNF agents (infliximab or adalimumab) reported a cumulative surgery rate of 47.2%, and a fistula closure rate of 27.0% at 5 years from the induction of anti-TNF therapy. [60]

Patients with advanced carcinoma may be treated with catheter drainage of the bladder alone or supravesical percutaneous diversion.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!