Journal ArticleDOI
Management of Bladder Fistulas in Crohn's Disease
TLDR
An enterovesical fistula in Crohn's disease rarely leads to serious complications and can often be treated successfully with medical therapy alone: by itself, it need not serve as an indication for surgery.Abstract:
We reviewed the course of 500 patients with Crohn's disease to document the incidence, the nature, and the results of management of fistulas to the bladder. Seventeen patients (14 men and three women) had developed enterovesical fistulas; 16 had pneumaturia. The barium radiographs demonstrated the fistula in only 37%. All had received sulfasalazine, and most were treated with corti-costeroids and antibiotics intermittently; two had successful control of their urinary symptoms on this regimen. Eight patients who received 6-mercaptopurine (6-MP) in addition tolerated the urinary fistula well, so that we encourage a trial of 6-MP for this complication of Crohn's disease. Six patients continue on medical therapy alone after a mean of 5.3 years. There were no instances of pyelonephritis during 60 patient years. Eleven patients eventually underwent bowel resection, but in only two was persistence of the enterovesical fistula the primary indication for elective surgery, and in both, it was the patient's choice. Visualization of the fistula on barium enema radiograph or presence of a connection between the sigmoid and the bladder were not associated with adverse outcome. An enterovesical fistula in Crohn's disease rarely leads to serious complications and can often be treated successfully with medical therapy alone; by itself, it need not serve as an indication for surgery.read more
Citations
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Journal ArticleDOI
Renal and urologic complications of inflammatory bowel disease.
TL;DR: Renal and urologic complications are not uncommon in patients with inflammatory bowel disease, and can be directly or indirectly related to the underlying disease process or its treatment.
Journal ArticleDOI
Diagnosis and management of fistulizing Crohn's disease
TL;DR: The epidemiology and pathology of fistulizing Crohn's disease is described, with particular focus on external and perianal fistulas, for which treatment options are well established.
Journal ArticleDOI
Management of internal fistulas in Crohn's disease.
Cynthia Levy,William J. Tremaine +1 more
TL;DR: Prospective trials of medical therapy and combination medical and surgical therapy for internal fistulas are needed to provide evidence to support the use of these new therapeutic approaches.
Journal ArticleDOI
Operative Management of Small Bowel Crohn's Disease
K. R. Gardiner,Bobby V.M. Dasari +1 more
TL;DR: There is increasing interest in nonsurgical and minimal access strategies of dealing with complicated disease, however, which may enable postponement of surgery to a more favorable time, or conversion of a two-stage procedure involving a stoma to a one-stage resection with anastomosis.
Journal ArticleDOI
Determination of Thiopurine Methyltransferase Genotype or Phenotype Optimizes Initial Dosing of Azathioprine for the Treatment of Crohn’s Disease
TL;DR: Patients with Crohn's disease and normal TPMT activity and patients with intermediate enzyme activity who were started on reduced doses of AZA did not develop acute leukopenia.
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