Pediatr Gastroenterol Hepatol Nutr.  2019 Jan;22(1):90-97. 10.5223/pghn.2019.22.1.90.

Enterourachal Fistula as an Initial Presentation in Crohn Disease

• Sankararaman S
• Sabe R
• Sferra TJ
• Khalili AS

• KMID: 2430921
• DOI: http://doi.org/10.5223/pghn.2019.22.1.90

Abstract

Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we describe a 17-year-old male who presented with a history of recurrent anterior abdominal wall abscesses and dysuria. He was diagnosed with Crohn disease and also found to have a fistulous communication between the terminal ileum and a patent urachus. An ileocecectomy with primary anastomosis and complete resection of the abscess cavity was performed. He is on azathioprine for maintenance therapy and currently in remission. Clinicians should have a high index of suspicion for this complication in Crohn disease patients presenting with symptoms suggestive of urachal anomalies such as suprapubic abdominal pain, dysuria, umbilical discharge, and periumbilical mass.

Keyword

Crohn disease; Inflammatory bowel diseases; Intestinal fistula; Urachus

MeSH Terms

Abdominal Pain
Abdominal Wall
Abscess
Adolescent
Azathioprine
Constriction, Pathologic
Crohn Disease*
Dysuria
Fistula*
Humans
Ileum
Inflammatory Bowel Diseases
Intestinal Fistula
Male
Urachus
Azathioprine

Figure

• 

  Fig. 1 (A) Sagittal computed tomography (CT) image of the abdomen and pelvis demonstrating the urachus (white arrows) which connects the urinary bladder (asterisk) and umbilicus (white arrow with black outline). The urachal remnant is thickened and distended with fluid and gas pockets (white arrow heads) consistent with an abscess. Also, the inflammatory stranding of the anterior abdominal wall is evident. (B) Axial CT image of the pelvis demonstrating the thickened wall of the distal ileum (white arrow) contiguous with the urachal remnant (white arrow head). This is suggestive of a fistula between these two structures. The urachal remnant appears edematous with a gas pocket which is consistent with an abscess and the edema extends to involve the adjacent abdominal wall. (C) Sagittal CT image of the abdomen and pelvis taken at an outside facility before the enterourachal fistula formation (5 months prior to this presentation). Urachal remnant (white arrows) extends from the anterior dome of the urinary bladder (asterisk) to the umbilicus (white arrow with black outline). (D) Axial magnetic resonance enterography with volumetric interpolated breath-hold examination image of the pelvis 3 minutes post contrast administration. Fistulous tract between urachal remnant and distal ileum clearly identified (white arrow with black outline). Marked thickening of the distal ileal wall (white arrow) and urachal remnant wall with some fluid remaining in the urachal remnant (white arrow head) consistent with an abscess.

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