保存的治療が奏効したクローン病による膀胱腸瘻の1例

Abstract

A 20-year-old man was admitted on February 2, 1990 with the chief complaint of pollakisuria, miction pain and macrohematuria. Urinalysis revealed numerous leukocytes and Enterobacter was identified by urine culture. Cystoscopy revealed an edematous region. Contrast film of small intestines demonstrated vesicoileal fistula. Judging from these and the radiographic findings, we made the diagnosis of vesicoileal fistula with Crohn's disease. After medical therapy between February 22 and May 25, urinalysis became normal and we assumed that the fistula had closed. Now, it is about a year since the therapy began, the patient remains well, without urinary and enteric symptoms. Cystoscopy and urinalysis did not reveal recurrence of the fistula. Despite previous reports that vesicoenteric fistulas complicating Crohn's disease require surgical treatment, this case responded to medication, and required no surgical treatment. This case is a reminder of the importance of the principle of therapy.