Surgical Management and Outcome of Entero-Urinary Fistula Complicating Crohn’s Disease: A Single Center Study

• Published in: World journal of surgery Vol. 47; no. 12; pp. 3365 - 3372
• Main Authors: Chen, Yusheng, Cao, Lei, Qiu, Jiayin, Li, Zhun, Guo, Zhen, Zhu, Zhenxing, Xu, Yihan, Qian, Wenwei, Zhu, Weiming, Li, Yi
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Bladder; Cardiac Surgery; Cecum; Complications; Crohn Disease - complications; Crohn Disease - surgery; Crohn's disease; Crohns disease; Diagnosis; Disease management; Fistula; Fistulae; General Surgery; Hematuria; Humans; Ileum; Intestinal Fistula - etiology; Intestinal Fistula - surgery; Medicine; Medicine & Public Health; Nutritional status; Optimization; Original Scientific Report; Patients; Postoperative; Postoperative Complications - etiology; Retrospective Studies; Signs and symptoms; Surgery; Thoracic Surgery; Urinary Bladder Fistula - diagnosis; Urinary Bladder Fistula - etiology; Urinary Bladder Fistula - surgery; Urinary Fistula - complications; Urinary Fistula - surgery; Urinary tract; Vascular Surgery
• ISSN: 0364-2313; 1432-2323; 1432-2323
• DOI: 10.1007/s00268-023-07196-x

Background Entero-urinary fistulas (EUF) are a rare complication of Crohn’s disease (CD), observed in 1.6 to 7.7%. The management of EUF complicating CD is challenging. We aimed to report the outcome and surgical management of EUF in CD. Methods A retrospective chart review was performed in all CD patients with EUF who underwent surgery in our center between January 2012 and December 2021. Patient demographics, preoperative optimization, surgical management, postoperative complications, and follow-up information were collected from a prospectively maintained database. Results A total of 74 eligible patients were identified. The median interval between CD diagnosis and EUF diagnosis was 2 (0.08–6.29) years. Patients with EUF presented with pneumaturia (75.68%), urinary tract infections (72.97%), fecaluria (66.22%), and hematuria (6.76%). Fistulae originated most commonly from the ileum (63.51%), followed by the colon (14.86%), the rectum (9.46%), the cecum (2.70%), and multiple sites (9.46%). The EUF symptoms, weight, nutritional status, laboratory results were significantly improved after preoperative optimization. The absence of EUF symptoms was observed in 42 patients after the optimization and only 9 of which required bladder repair. However, 19 of 32 patients whose symptoms did not resolve required bladder repair ( P  = 0.001). Only 1 patient developed a bladder leakage in the early postoperative period and 3 patients experienced recurrent bladder fistula. Conclusions Surgical management of EUF complicating CD is effective and safe, with a low rate of postoperative complication and EUF recurrence. Preoperative optimization, which is associated with the resolution of urinary symptoms and improved surgical outcomes, should be recommended.