Mechanical Intestinal Obstruction in Ch. Fistulas may also occur. The most common fistulas are sigmoidovesical, which are apt to occur in men and in women who have had a hysterectomy. Other fistulas can perforate into the small bowel, uterus, vagina, abdominal wall, or even the thigh or the mediastinum. Treatment consists of segmental resection of the portion of bowel from which the fistula arose and anastomosis, which usually can be performed in one stage.
Symptoms usually subside rapidly.
The patient gradually advances to a soft low-roughage diet and a daily psyllium seed preparation. A barium enema 2 wk later can confirm the diagnosis. After 1 mo, a high-roughage diet is resumed. If response is satisfactory, the patient remains hospitalized until symptoms are relieved and a soft diet is resumed. Increasing pain, tenderness, and fever are danger signs.