[Entero-enteral fistulas in Crohn disease: radical or conservative surgical treatment of the "victim" segment?].

OBJECTIVES AND METHODS

Entero-enteral fistulas join a segment affected by Crohn's disease to another which becomes a drainage route and a "victim" of the process. Surgical treatment can be radical (extensive resection of both segments) or conservative (resection of involved bowel and conservation of the "victim"). Fifty-nine patients operated on for Crohn's disease and having 80 entero-enteral fistulas were retrospectively studied.

RESULTS

Main surgical indications were symptomatic intestinal stenosis (56%) or abdominal mass (20%) unresponsive to medical treatment. Fistula was discovered during operation in 33 patients (56%). Conservative treatment was performed in 39 fistulas (49%). In 41 fistulas (51%), proximity of fistulous ends, or Crohn's disease's extension, led to radical treatment. In 66 fistulas (82.5%), histologic examination revealed that Crohn's disease affected only one bowel segment, the other demonstrating only non specific features; in the 14 remaining fistulas (17.5%), Crohn's disease affected both segments.

CONCLUSIONS

The clinical presentation of entero-enteral fistulas (non-specific symptoms, frequent peroperative diagnosis), their pathological features (victim segment often free of Crohn's disease) plead for a conservative surgical approach, i.e. adapted to real bowel involvement by Crohn's disease.