Enterovesical fistula in Crohn's disease
Recurrent urinary tract infection in a patient treated for chronic inflammatory bowel disease.
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Circumferential bowel wall thickening with luminal narrowing and mucosal enhancement of two ileal segments: terminal ileum (8.5 cm long) and the ileal loop above (9 cm long), separated by a small normal segment (3 cm long). There is an enhancing fistulous track extending from an ileal loop to the dome of the urinary bladder with a thickened and enhanced bladder wall. Note prominent mesenteric vasculature with peri-ileal inflammatory stranding and minimal adjacent effusion.
In Crohn's disease, enterovesical fistula is an uncommon but potentially dangerous complication. It is the most frequent form of urinary tract fistula, most likely due to the close proximity of the ileal loops and the bladder. It is important to be aware of this complication because it can be the initial manifestation of Crohn's disease. The required treatment in most cases is surgical (suture of bladder wall and resection of the involved bowel segment).