title: [Digestive fistulas in Crohn's disease].
abstract: From 1977 up to 1983, 29 patients were operated upon for Crohn's disease with digestive fistula (dead fistulae, ileocecal and contiguous ileoileal fistulae being excluded). The majority of the fistulae arose from the distal ileum (n = 22). After an average duration of the disease of 7 1/2 years, the patients were admitted for surgical treatment, either electively (group I, n = 19), or in urgency (group II, n = 10). Eleven patients exhibited some signs of malnutrition, 13 needed a total parenteral nutrition for an average of 10 days; one patient had to be operated upon in emergency (hemorrhage and sepsis); the others had a normal bowel preparation. The resection of the diseased bowel at the origin of the fistulae included right ileocolic resections (n = 25), left (n = 1) or total (n = 3) colectomies, with primary anastomosis in all but two cases. The "target bowel" was treated as conservatively as possible: limited small bowel resection, single suture of the gastric, duodenal or sigmoidal walls, and bladder drainage. A segmental resection of the sigmoid colon was realized in 5 cases where a single closure of the wall defect was impossible. There was no postoperative death, no septic complications, and no signs of anastomotic dehiscence. Fistula recurrence "in situ" occurred only once. A spectacular health improvement, with a significant weight gain, was observed in 85% of the cases. Further outcome of the disease remains out of control.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003108:Colonic Diseases / Q000209:etiology; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology; D005747:Gastric Fistula / Q000209:etiology; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology / Q000601:surgery*; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012810:Sigmoid Diseases / Q000209:etiology; D012871:Skin Diseases / Q000209:etiology; D001747:Urinary Bladder Fistula / Q000209:etiology
vernacular_title: Fistules digestives dans la maladie de Crohn.