Abstract
This paper deals with a case of Crohn's disease (CD) in which an enterovesical fistula which had been formed 23 years earlier developed to be advanced cancer. The patient was a 52-year-old man who had been diagnosed as having CD including the small intestine and the colon at the age of 29. At the same time he was pointed out a vesicle fistula as well, but he refused surgery. Thereafter he had been treated with nutritional therapy and administration of 5-ASA preparation until recently (52 years of age) when he was found having a rectum-bladder-ileum fistula and hematurea. A biopsy of the cystic wall offered a diagnosis of mucinous adenocarcinoma. We thus performed ilectomy, Hartmann operation, sigmoid colostomy, and cystoprostatectomy with the diagnosis of enterovesical fistula caused by CD and carcinoma arisen from the fistula. It revealed that the terminal ileum, the bladder, and the rectum had formed a mass and communicated via the fistula. The histopathological diagnosis was also mucinous adenocarcinoma, and it was likely that the carcinoma arisen in the fistula invaded especially toward the bladder. After discharge from the hospital, he was treated with chemotherapy but died of cancer 6 months after the operation.
Although a risk of entailing carcinogenesis of internal fistula in CD patients is still unknown, we consider that surgery must actively be selected for internal fistula because there have been some cases in which cancer change of the fistula occurred like this case.
