Operative treatment of Crohn's ileocolitis complicated by ileosigmoid and ileovesical fistulae.

Ileovesical and ileosigmoid fistulae were found to coexist in 22 patients with Crohn's ileocolitis. Persistent or recurrent urinary tract infection was a complaint in all cases, and 11 patients reported pneumaturia and/or fecaluria. Thus, bladder involvement was either suspected or clinically apparent in each patient. The cystogram was the best confirmatory test for the ileovesical fistula (positive in 9 of 22 patients). The coexistence of the sigmoid fistula was best diagnosed on intestinal radiographs (positive in 9 of 22 patients); there were no clinical signs of its presence. The coexistence of ileosigmoid and ileovesical fistulae was the sole indication for operation in two patients. In all others, a combination of factors required surgical therapy. An ileocolonic resection with primary intestinal anastomosis was performed in 16 patients and exteriorization was performed in six patients. The sigmoid defect was closed primarily in 16 patients and required wedge resection in the other six patients. The bladder defect was sparingly excised and closed with absorbable sutures. All patients recuperated without anastomotic leaks, bladder leaks, or persistent cystitis. This experience indicates that coexisting ileosigmoid and ileovesical fistulae may add complexity to an ileocolonic resection for Crohn's disease, but is not a difficult management problem for the gastrointestinal surgeon.