Crohn Disease in 8 Patients with Fistula from a Perineal Wound to the Ileum Following Abdominoperineal Resection

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  • 直腸切断術後に小腸と会陰創間に瘻孔を形成したクローン病8例の検討

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Eight patients with fistula from a perineal wound to the ileum following abdominoperineal resection (APR) for Crohn disease were reported. The cause of this specific fistula is delayed healing of a perineal wound after APR which did not close for more than 6 months in 6 patients, and ileal lesion in 2 patients, one of which was Crohn disease and the other was anastomotic leakage without Crohn disease. Partial ileal resection with drainage of the fistula tract was performed in all patients and no recurrence of the fistula after surgery was found in 5 patients (63%). The other 3 patients had recurrence of fistula and reoperation was performed in one. All 3 patients were treated to maintain drainage into the pelvic cavity for the persisting purulent discharge and fistula from the ileum were detected in 2 afterwards. Fistula from a perineal wound to the ileum caused by delayed perineal or ileal lesion healing is a rare complication of Crohn disease and can be treated by abdominoperineal resection. Partial resection of the ileal fistula was effective. However, recurrence was found in patients who have persistent infection in the fistula tract with purulent discharge. It is necessary to establish optimal treatment and preventive methods for this intractable complication.

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