案例報告:克隆氏症併發腸膀胱廔管的手術處理
蔡尚錞、黃志平1
中國醫藥大學附設醫院, 1中國醫藥大學附設醫院 泌尿部, 性荷爾蒙研究中心
A case report: surgical management in a Crohn’s disease patient complicated with vesicoenteric fistula.
Shang-Chun Tsai, Chi-Ping Huang1
China Medical Hospital, 1Departments of Urology and Medical Technology, Sex Hormone Research Center, China Medical Hospital, Taichung, Taiwan
Introduction: The vesicoenteric fistula(VEF) due to Crohn’s disease(CD) is rare. There are two choices of management: medical and surgical treatment. This article will illustrate considerations of surgical management in a CD patient complicated with VEF.
Case reprot: A 34-year-old Asian male with history of anal fistula and Crohn’s disease was admitted to our hospital due to recurrent urinary tract infection for months. However, in this case, VEF could not be identified through cystoscopy and cystogram. Due to progressive lower urinary tract symptoms(LUTS), deteriorating renal function, and poor response with medical treatment, the patient underwent exploratory laparotomy. Fistula was diagnosed and resected. Partial cystectomy and segmental resections of small bowel were also done.
Discussion: VEF could not be identified through cystoscopy and cystogram There is no golden indication illustrated when to perform exploratory laparotomy is the best choice. In this case, there were some reasons to perform surgical management. After surgery, no recurrence was noted with a follow-up time of at least 9 months, and renal function got improved.
Conclusions: Surgical intervention is imperative in some situations, even though imaging of cystogram or cystoscopy dose not strongly support the diagnosis of VEF.