Ileocolitis with Fistula

Patients with ileocolitis can be divided into two major categories. About half of the patients will present with obstructive symptoms due to strictures either in the colon or ileum. The rest have disease that manifests itself mainly by the presence of fistulas. Some of these fistulas may be entero-enteric or enterovesical. Often the fistulas drain into the intestinal mesentery or retroperitoneum, and these patients present with chronic pain, fever, and weight loss. Many patients with fistulas have chronic phlegmons, which have a thick wall and some purulent content. Most of these phlegmons can be resected with the segment of diseased bowel. Patients presenting with an acute abscess containing a large amount of purulent material benefit from CT-guided drainage and antibiotics prior to surgical resection. Fortunately, free perforation rarely occurs in patients with Crohn’s disease. Colonic strictures are especially troublesome when they do not allow for colonic surveillance and occasionally may be caused by a carcinoma. The presence of these strictures is a common indication for surgery.