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01.09.2004 | Original Article | Ausgabe 5/2004

International Journal of Colorectal Disease 5/2004

Surgical management of entero and colocutaneous fistulae in Crohn’s disease: 17 year’s experience

Zeitschrift:
International Journal of Colorectal Disease > Ausgabe 5/2004
Autoren:
Lisa S. Poritz, G. Alessandra Gagliano, Robin S. McLeod, Helen MacRae, Zane Cohen
Wichtige Hinweise
An invited commentary on this paper is available at http://​dx.​doi.​org/​10.​1007/​s00384-004-0581-9

Abstract

Background and aims

Fistulous disease is common in Crohn’s disease, and entero- and colocutaneous fistulae are particularly debilitating and difficult to manage. We present the results of surgical management of these fistulas.

Patients and methods

Retrospective chart review of all 51 patients with Crohn’s disease (56 surgical procedures) undergoing surgery for cutaneous fistulae between 1983 and 2000.

Results

Previous surgery for Crohn’s disease had been carried out in 43 patients (84%). The fistula site was enterocutaneous in 36 patients (64%), colocutaneous in 12 (21%), and anastomotic in 8 (14%); 9 patients (16%) also had associated enteroenteric fistulas. The onset of the fistula followed abscess drainage in 15 (27%) and occurred at the site of recurrent disease in 41 (73%). Forty patients (71%) initially underwent conservative management prior to surgery; 16 (28%) underwent surgery directly. Surgical procedures were: 25 ileocolic resections, 8 stoma revisions with resection, 8 small bowel resections 7 subtotal colectomies, 4 partial colectomies, 3 proctocolectomies, and one fistula tract excision. Mean total length of stay was 18 days (postoperative 10.7 days). Six (11%) patients had eight postoperative complications. Mean follow-up was 48.6 months (range 3–187). Recurrence as defined by either clinical examination or reoperation was documented in nine fistulas (16%), with a mean time to recurrence of 27 months.

Conclusion

Entero-and colocutaneous fistulae usually occur from a site of active disease. Surgical management with bowel resection, including the fistula, is the preferred method of treatment. Morbidity has been low and recurrence rate lower than expected.

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