Surgical management of ileosigmoid fistulas in Crohn's disease.

Radiologic and endoscopic demonstration of ileosigmoid fistulas is difficult: some are discovered only at operation. In these cases the surgeon is faced with the decision of either to remove "en bloc " the involved bowel or to simply close the sigmoid defect. Twelve patients with Crohn's disease complicated by ileosigmoid fistulas were operated: 7 by ileal and/or colonic resection and simple closure of the sigmoid fistula, 4 by double resection and 1 by total colectomy. Stomas were performed in 2. The review of this experience demonstrated that conservative surgery is effective and safe in most cases. Local extended resection should be reserved to cases where secondary involvement of a rather long segment of the intestine is present or where the sigmoid and rectum are primarily involved by active severe Crohn's disease. In these cases, a protective stoma may be considered.