Enterocutaneous Fistula

enterocutaneous fistula

This 44 year-old female with known Crohn’s disease, and a history of multiple laparotomies, enterocutaneous and enterovaginal fistulae presented with abdominal pain and active cutaneous fistula. She had not passed motions per rectum for 2 weeks.

This axial CT scan shows loops of small bowel closely apposed to anterior abdominal wall, with a fistula to skin outlined by contrast. No contrast passed through to colon. A staple-ring anastomosis is visible in the sigmoid colon.

Crohn’s disease is an idiopathic inflammatory bowel disease with discontinuous and asymmetric involvement of the entire gastrointestinal tract. It is characterised by transmural non-caseating granulomatous inflammation. The usual onset is between 15 and 30 years, with no sex predominance. Presentation is with abdominal pain, fever, weight-loss, anaemia, perianal abscess or fistula, or malabsorption. There is involvement of the small bowel in 80% of cases, which manifests as fold thickening, aphthous ulcers, extensive mucosal ulceration, or as in this case, fistulas to skin, bowel, bladder or vagina.

Reference: Dähnert W. Radiology Review Manual, 5th edition, Lippincott, Williams & Wilkins, 2003.

Credit: Dr Laughlin Dawes