克隆氏症相關迴腸膀胱廔管之病例報告

謝棨圳^1,2、 王巽玄¹

¹高雄市立小港醫院院泌尿科

²高雄醫學大學附設中和紀念醫院泌尿部

Ileovesical Fistula Related to Crohn’s Disease: A Case Report

Chi-Chun Hsieh^1,2, Hsun-Shuan Wang^1,2

¹Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan

²Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Abstract

Background

Crohn’s disease is inflammatory bowel disease related to chronic inflammation. It is characterized by transmural inflammation may involve any portion of luminal gastrointestinal tract. When formation of sinus tracts occurs, it may even lead to fistula with abscess formation after penetrating the serosa. We report a case diagnosed as ileovesical fistula related to Crohn’s disease.

Cases Presentation

A 42-year-old male complained about pneumaturia for a while especially when abdominal fullness. He also suffered from persistent urinary tract infection. He had history of Crohn disease. Inflammatory bowel with ileus was ever noted. Recent computed tomography showed thickened intestinal wall with severe adhesion to bladder. Cystoscopy showed protruded mass lesion with tract like lesion beneath it. Ileovesical fistula was confirmed after injection of Urografin into the tract from the bladder side. Contrast leakage to the gastrointestinal tract was noted under fluoroscopy. No malignancy was noted according to biopsy report of bladder lesion. The patient preferred conservative treatment due to tolerable symptoms.

Conclusion

Crohn's disease may cause chronic transmural inflammation, which could penetrate the serosa and give rise to fistulas. Enterovesical fistulas lead to recurrent urinary tract infections, often with multiple organisms, and to pneumaturia, which was seen in our case.