Management of fistulas in Crohn's disease.
OBJECTIVE
This study was conducted to clarify operative indications, surgical treatment, and postoperative complications of intra-abdominal fistulas in Crohn's disease.


METHODS
Of 213 patients undergoing surgical treatment for Crohn's disease in our institution between 1972 and 2000, 55 patients (25.8%) found to have 81 intra-abdominal fistulas were retrospectively reviewed.


RESULTS
The most common indication for surgery was intestinal obstruction. A fistula represented a single indication for surgical treatment in 9 operations (15.5%). All patients with intra-abdominal fistulas underwent resection of the diseased intestinal segment. Closure of the fistulous defect of the affected lesion was achieved by suture (n = 27), stapled fistulectomy (n = 12), or resection (n = 11). Resection of the diseased bowel was achieved by en bloc removal of the fistula in 15 cases. When the fistula opened through the abdominal wall (n = 12), the diseased portion of the intestine was resected, and the fistulous tract was debrided. Only 1 patient died postoperatively from multiple organ failure because of anastomotic breakdown.


CONCLUSIONS
The surgical treatment of an intra-abdominal fistula in Crohn's disease is based on resection of the diseased intestinal segments, and the affected lesion can be sutured. This procedure can be achieved safely, and the incidence of postoperative complications is low.
Ikeuchi
Hiroki
H
2nd Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. ikeuci2s@hyo-med.ac.jp
Shoji
Yasutugu
Y
Yamamura
Tekehira
T
D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001747:Urinary Bladder Fistula / Q000209:etiology* / Q000601:surgery*