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...
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Answer

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.


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