Patel Vikas J, Homsi Maher, Orriols Nicholas A, Chaudhry Naueen A, Grajo Joseph R, Malkawi Abdullah, Moser Patricia, Molina Isaac L, Case Robert, Ayoub Fares, Kaufman Nicholas I, Lambrou Tiffany, Zimmermann Ellen M
Division of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, Florida.
Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida.
Gastro Hep Adv. 2025 Apr 25;4(8):100684. doi: 10.1016/j.gastha.2025.100684. eCollection 2025.
Internal fistulas found on cross-sectional imaging (CSI) performed during routine care of patients with Crohn's disease (CD) are often considered incidental findings. This study aimed to assess outcomes in patients with internal fistulas on CSI.
This is a single tertiary care center, retrospective case-control study of CD outcomes. Patients who had magnetic resonance enterography or computer tomography enterography performed between 2007 and 2017 were included. Electronic medical record data up to 2017 were included as variables in logistic regression analysis. CSI was scored by 3 abdominal radiologists blinded to the electronic medical record.
Subjects included 199 CD patients: 63 patients (cases) had internal fistulas on index scan and 136 had no internal fistula. The cases and controls were well-matched for age, race, smoking status, body mass index, and years of disease. During follow-up, cases had a more complicated disease course with higher incidence of intra-abdominal abscess formation (19.1% vs 3.7%; < .001) and abdominal surgery (44.4% vs 24.3%; < .001). Patients with fistula were more likely to require surgery (odds ratio 4.96, < .001) and to develop intra-abdominal abscess (odds ratio 6.05, < .001). The index scan of cases was more likely to demonstrate inflammation (95.2% vs 39.7%; < .001) and stricture (27.0% vs 7.35%; < .001) than controls though the presence of an internal fistula was the only independent variable predictive of intra-abdominal abscess.
CD patients with internal fistulas identified by CSI have worse disease outcomes. Presence of internal fistula is the only independent risk factor for future intra-abdominal abscess regardless of the patient's symptoms.
在克罗恩病（CD）患者常规护理期间进行的横断面成像（CSI）检查中发现的内瘘通常被视为偶然发现。本研究旨在评估CSI检查发现有内瘘的患者的预后情况。
这是一项在单一三级医疗中心进行的关于CD预后的回顾性病例对照研究。纳入了2007年至2017年间接受磁共振小肠造影或计算机断层扫描小肠造影的患者。截至2017年的电子病历数据作为逻辑回归分析中的变量。CSI由3名对电子病历不知情的腹部放射科医生进行评分。
研究对象包括199例CD患者：63例（病例组）在首次扫描时有内瘘，136例无内瘘。病例组和对照组在年龄、种族、吸烟状况、体重指数和病程方面匹配良好。在随访期间，病例组的疾病进程更为复杂，腹腔内脓肿形成的发生率更高（19.1%对3.7%；P<0.001），腹部手术的发生率也更高（44.4%对24.3%；P<0.001）。有瘘的患者更有可能需要手术（优势比4.96，P<0.001）和发生腹腔内脓肿（优势比6.05，P<0.001）。与对照组相比，病例组的首次扫描更有可能显示炎症（95.2%对39.7%；P<0.001）和狭窄（27.0%对7.35%；P<0.001），尽管存在内瘘是腹腔内脓肿的唯一独立预测变量。
通过CSI检查发现有内瘘的CD患者预后较差。无论患者症状如何，内瘘的存在是未来腹腔内脓肿的唯一独立危险因素。
