Management of Enterovesical Fistula in a Patient with Crohn’s Disease: A Case Report and Literature Review
Enterovesical fistula (EVF) is a rare complication of Crohn’s disease (CD), characterized by recurrent urinary tract infections, fecaluria, and pneumaturia. However, most diagnostic tools have low sensitivity for EVF. Management consists of conservative and surgical approaches. Conservative treatmen...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/9/1527 |
| _version_ | 1797602829734510592 |
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| author | Ming-Wei Hsu Wen-Chi Chen Ting-Na Wei Chi-Ping Huang |
| author_facet | Ming-Wei Hsu Wen-Chi Chen Ting-Na Wei Chi-Ping Huang |
| author_sort | Ming-Wei Hsu |
| collection | DOAJ |
| description | Enterovesical fistula (EVF) is a rare complication of Crohn’s disease (CD), characterized by recurrent urinary tract infections, fecaluria, and pneumaturia. However, most diagnostic tools have low sensitivity for EVF. Management consists of conservative and surgical approaches. Conservative treatment is usually adopted first. However, the appropriate time to consider surgery remains controversial. Herein, we report on the case of a 34-year-old male who presented with diffuse abdominal pain with fullness for one day. Enteroscopy and biopsy confirmed the diagnosis of Crohn’s disease. Contrast-enhanced computed tomography (CT) suggested a fistula between the ileum and urinary bladder; however, cystoscopy did not find an obvious tract. The patient initially received medical treatment, but the symptoms persisted with recurrent urinary tract infections and subsequent bilateral hydronephrosis. He then underwent successful fistulectomy, partial cystectomy, and two segmental resections of the small bowel with end-to-end primary sutures. No complications or symptomatic urinary tract infections were noted during 30 months of follow-up after surgery, suggesting no recurrence of EVF. Surgical intervention is warranted when medical treatment fails or complications occur. Clinical symptoms and laboratory data are often less informative for the diagnosis of EVF, and CT is the most helpful diagnostic modality. Our management strategy provides an option for such patients. |
| first_indexed | 2024-03-11T04:20:56Z |
| format | Article |
| id | doaj.art-32e88f65e52f40ee8e7aba4bf825627c |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T04:20:56Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-32e88f65e52f40ee8e7aba4bf825627c2023-11-17T22:44:53ZengMDPI AGDiagnostics2075-44182023-04-01139152710.3390/diagnostics13091527Management of Enterovesical Fistula in a Patient with Crohn’s Disease: A Case Report and Literature ReviewMing-Wei Hsu0Wen-Chi Chen1Ting-Na Wei2Chi-Ping Huang3Department of Urology, China Medical University Hospital, Taichung 404327, TaiwanDepartment of Urology, China Medical University Hospital, Taichung 404327, TaiwanDepartment of Radiation Oncology, Taichung Veterans General Hospital, Taichung 40705, TaiwanDepartment of Urology, China Medical University Hospital, Taichung 404327, TaiwanEnterovesical fistula (EVF) is a rare complication of Crohn’s disease (CD), characterized by recurrent urinary tract infections, fecaluria, and pneumaturia. However, most diagnostic tools have low sensitivity for EVF. Management consists of conservative and surgical approaches. Conservative treatment is usually adopted first. However, the appropriate time to consider surgery remains controversial. Herein, we report on the case of a 34-year-old male who presented with diffuse abdominal pain with fullness for one day. Enteroscopy and biopsy confirmed the diagnosis of Crohn’s disease. Contrast-enhanced computed tomography (CT) suggested a fistula between the ileum and urinary bladder; however, cystoscopy did not find an obvious tract. The patient initially received medical treatment, but the symptoms persisted with recurrent urinary tract infections and subsequent bilateral hydronephrosis. He then underwent successful fistulectomy, partial cystectomy, and two segmental resections of the small bowel with end-to-end primary sutures. No complications or symptomatic urinary tract infections were noted during 30 months of follow-up after surgery, suggesting no recurrence of EVF. Surgical intervention is warranted when medical treatment fails or complications occur. Clinical symptoms and laboratory data are often less informative for the diagnosis of EVF, and CT is the most helpful diagnostic modality. Our management strategy provides an option for such patients.https://www.mdpi.com/2075-4418/13/9/1527Crohn’s diseaseenterovesical fistulaurinary tract infectionsurgerycomputed tomography |
| spellingShingle | Ming-Wei Hsu Wen-Chi Chen Ting-Na Wei Chi-Ping Huang Management of Enterovesical Fistula in a Patient with Crohn’s Disease: A Case Report and Literature Review Diagnostics Crohn’s disease enterovesical fistula urinary tract infection surgery computed tomography |
| title | Management of Enterovesical Fistula in a Patient with Crohn’s Disease: A Case Report and Literature Review |
| title_full | Management of Enterovesical Fistula in a Patient with Crohn’s Disease: A Case Report and Literature Review |
| title_fullStr | Management of Enterovesical Fistula in a Patient with Crohn’s Disease: A Case Report and Literature Review |
| title_full_unstemmed | Management of Enterovesical Fistula in a Patient with Crohn’s Disease: A Case Report and Literature Review |
| title_short | Management of Enterovesical Fistula in a Patient with Crohn’s Disease: A Case Report and Literature Review |
| title_sort | management of enterovesical fistula in a patient with crohn s disease a case report and literature review |
| topic | Crohn’s disease enterovesical fistula urinary tract infection surgery computed tomography |
| url | https://www.mdpi.com/2075-4418/13/9/1527 |
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