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Presentation Description
Institution: Royal Brisbane and Women's Hospital - QLD, Australia
Purpose: The management of Crohn’s disease (CD) complicated by ileosigmoid fistula (ISF) remains a challenge, and Australian outcomes have not previously been reported
Methods: A retrospective review of a tertiary colorectal inflammatory bowel disease unit, across public and private sites, from 2005-2023 to identify adult patients having undergone operative management of ISF.
Results: Twenty-nine patients underwent surgery for ISF in the study period. Seventeen were male and the median age was 40 years. The pre-operative diagnosis of ISF was made in 76%. Sixty-nine percent of cases were performed electively, with 76% completed laparoscopically and a 18.5% conversion rate. The ISF was oversewn in three patients, repaired primarily in 14 patients, managed with segmental wedge resection in eight patients and resected via an anterior resection in four patients. The rate of stoma formation at the index procedure was 20.7% overall and 22% in patients managed being acutely managed with steroids. Morbidity was 17.2% with a single anastomotic leak.
Conclusions: ISF in CD remains difficult to diagnose pre-operatively, but can be safely managed laparoscopically without formal resection, and with limited use of diverting stoma formation. The specific surgical approach to the sigmoid in ISF is difficult to pre-determine and often requires decisions to be made intra-operative.
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Authors
Authors
Dr Ashley Jenkin - , Mrs Aleksandra Edmundson - , Professor David Clark -