We reviewed the course of 500 patients with
Crohn's disease to document the incidence, the nature, and the results of management of
fistulas to the bladder. Seventeen patients (14 men and three women) had developed enterovesical
fistulas: 16 had pneumaturia. The
barium radiographs demonstrated the
fistula in only 37%. All had received
sulfasalazine, and most were treated with
corticosteroids and
antibiotics intermittently; two had successful control of their urinary symptoms on this regimen. Eight patients who received
6-mercaptopurine (6-MP) in addition tolerated the
urinary fistula well, so that we encourage a trial of 6-MP for this complication of
Crohn's disease. Six patients continue on medical
therapy alone after a mean of 5.3 years. There were no instances of
pyelonephritis during 60 patient years. Eleven patients eventually underwent bowel resection, but in only two was persistence of the enterovesical
fistula the primary indication for elective surgery, and in both, it was the patient's choice. Visualization of the
fistula on barium enema radiograph or presence of a connection between the sigmoid and the bladder were not associated with adverse outcome. An enterovesical
fistula in
Crohn's disease rarely leads to serious complications and can often be treated successfully with medical
therapy alone: by itself, it need not serve as an indication for surgery.