Crohn’s disease presenting as a ceco-urachal fistula

Abstract

We report the case of a patient with Crohn's disease who initially presented with a ceco-urachal fistula. The patient was a 31-year-old female who underwent an appendectomy 6 years before presenting to our institution. She had a one-year history of diarrhea, and had recently developed polyuria and a sensation of residual urine. She was admitted with fever and lower abdominal pain. Endoscopy and computed tomography revealed a ceco-urachal fistula, which was consistent with Crohn's disease. An urachal resection was performed, which included partial cystectomy and ileocecal resection. A ceco-urachal fistula is a rare initial symptom of Crohn's disease. During the surgical management of such cases, it is necessary to resect the urachus, the affected portion of the bladder, the fistula, and the affected part of the digestive tract in order to avoid recurrence.

Enterourachal Fistula as an Initial Presentation in Crohn Disease

“…Fistula may form between adjacent bowel loops and any adjacent structure including the retroperitoneum, urinary bladder, vagina, and skin. A fistulous communication between urachus and inflamed bowel from CD is exceedingly rare and only a few cases are reported [123456789101112]. Due to the rarity and nonspecific presentation, the diagnosis of enterourachal fistula can be delayed [9].…”

“…We did a systematic literature search of MEDLINE and Embase databases using the following terms Crohn's disease, inflammatory bowel disease, IBD, urachus, and urachal. We identified descriptions of twelve cases of CD with an associated urachal complication (Table 1) [123456789101112]. In non-English language journal articles, only abstracts were reviewed and included.…”

“…Paşalega et al [14] reported a patient with CD and infected urachal cyst. Including the patient reported here, the total number of CD patients with urachal anomalies reported in the literature since the publication of first case in the year 1980 is seventeen [123456789101112131415].…”

“…The age range of these patients was between 11 to 31 years and the median age was 19 years [123456789101112]. The male-to-female ratio was almost equal.…”

Crohn’s disease manifesting as ileo-urachal fistula: Two cases reports and review of literatures

“…Seventeen cases have been reported globally, including our cases ( Table 1 ) [ 1 , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. There was only three reported cases only of pyourachus in patients with Crohn’s disease in Japan [ 11 ], including both of our cases. Fourteen cases had an ileal lesion.…”