Schraut W H, Block G E
Am J Gastroenterol. 1984 Mar;79(3):186-90.
An enterovesical fistula, an infrequent complication of Crohn's ileocolitis which is considered to constitute a difficult surgical problem, was encountered in 29 patients. These patients had been treated for Crohn's disease by medical means for years and several had previously undergone bowel resections. An exacerbation of the Crohn's disease occurred in all patients coincident with the appearance of dysuria or the obvious clinical presentation (fecaluria) of the fistula. Other manifestations of active Crohn's disease frequently coexisted. Radiographic evaluation was of limited help in establishing the presence of the fistula. Cystoscopy was suggestive of the diagnosis in 18 of 20 patients so examined. Treatment consisted of ileocecal resection with primary anastomosis (25) or exteriorization (4). The bladder defect was sparingly excised and closed with absorbable sutures. One patient developed a bladder leak which closed spontaneously. Recovery was uneventful in the others. An ileovesical fistula constitutes an indication for operation not only to eradicate the urinary sepsis but also to correct the other complications (malnutrition, obstruction, abscess) of Crohn's disease. To assure an uncomplicated course, emphasis must be placed on an individually designed correct approach to the (causative) intestinal problem, while the surgical aspects of the bladder defect can be a matter of routine.
29例患者出现了小肠膀胱瘘，这是克罗恩病回结肠型的一种罕见并发症，被认为是一个棘手的外科问题。这些患者多年来一直采用药物治疗克罗恩病，部分患者此前曾接受过肠切除术。所有患者在出现排尿困难或瘘管明显临床表现（粪尿）时，克罗恩病均出现加重。同时常伴有活动性克罗恩病的其他表现。影像学评估对确定瘘管的存在帮助有限。在接受膀胱镜检查的20例患者中，18例提示诊断。治疗方法包括回盲部切除并一期吻合（25例）或外置（4例）。膀胱缺损处少量切除后用可吸收缝线缝合。1例患者出现膀胱渗漏，但自行愈合。其他患者恢复顺利。小肠膀胱瘘不仅是根除尿源性败血症的手术指征，也是纠正克罗恩病其他并发症（营养不良、梗阻、脓肿）的指征。为确保病程顺利，必须强调针对（病因性）肠道问题采取个体化设计的正确方法，而膀胱缺损的手术处理则可按常规进行。
