Intra-abdominal fistulas in surgically treated Crohn's disease patients.
BACKGROUND
Intra-abdominal fistulas occur in one-third of patients with Crohn's disease (CD). Although they are common, these fistulas may pose difficult problems for the surgeon. We assessed the clinical presentation of intra-abdominal fistulas in patients with CD and compared the clinicopathologic characteristics of CD with and without fistulas.


METHODS
We analyzed consecutive laparotomy cases for 254 patients with CD between 1991 and 2008. Clinicopathologic data were abstracted from patient charts and a prospectively maintained database. Patient variables with and without fistulas were analyzed using the Fisher's exact test, chi-square test, and Student's t test.


RESULTS
A total of 93 surgical procedures were performed on 83 patients (32.7%) who had at least one intra-abdominal fistula, revealing a total of 122 fistulas. Enteroenteric fistulas were the most common (30.3%), followed by enterocutaneous (23%), enterosigmoid (19.7%), enterocolonic (9.7%), and enterovesical (9.7%). Most cases (95.7%) underwent intestinal resection, with primary anastomosis in 77 of the cases (82.8%). There was no mortality, although 15 (16.1%) patients experienced postoperative complications. In the comparison of 270 cases with and without fistulas, cases with fistulas tended to have more frequent surgeries for perianal fistulas or abscesses (P = 0.001), more frequent intra-abdominal abscesses on CT (P = 0.044), and a higher incidence of combined small bowel and colonic disease (P < 0.001).


CONCLUSIONS
The incidence and clinical features of fistulas were similar to those reported in previous studies of western patients. We identified that patients with CD and fistulas have more frequent other CD-related sepsis.
Yoon
Yong Sik
YS
Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea.
Yu
Chang Sik
CS
Yang
Suk-Kyun
SK
Yoon
Sang Nam
SN
Lim
Seok-Byung
SB
Kim
Jin Cheon
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D016154:Digestive System Fistula / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome