SIGMOID-SPINAL FISTULA IN A PATIENT WITH CROHN'S DISEASE - CASE REPORT

BNF, a 22-year-old female, was diagnosed with Crohn's Disease (CD) in 2022 through colonoscopy and enterotomography, showing stenosing involvement of the distal ileum and sigmoid. She started immunobiological therapy with infliximab in February 2023 and, in August, presented with abdominal pain and complaints of bilateral sacroiliac pain, mainly on the left, with neuropathic pain and reduced mobility of the left lower limb, with suspected sacroiliitis secondary to Crohn's Disease. An MRI of the lumbosacral spine and CT of the abdomen were requested, revealing a fistulous tract from the sigmoid toward the sacrum, with a spinal collection and paravertebral extension posterior to the L5-S1 vertebral foramen, with heterogeneous collections. Due to the complication of a spinal fistula and the development of septic shock, the decision was made to perform laparotomy with a Maylard transverse incision. The surgery revealed a fistula in the terminal ileum and sigmoid with retroperitoneal abscess extension on the left, requiring segmental enterectomy with double-barrel ileostomy and rectosigmoidectomy with terminal colostomy. The patient received antibiotic therapy and corticosteroids, with good postoperative recovery, improvement in the infectious condition, and resolution of neurological symptoms. Ambulatorily, the infliximab dose was optimized to 5mg/kg every 4 weeks after corticosteroid tapering. She underwent reconstruction of the bowel in February 2024 with colorectal anastomosis and subsequent endoscopic dilation of the anastomosis. In May 2024, a double-barrel ileostomy enteroanastomosis was performed. She continues to show good clinical progress with optimized infliximab therapy, achieving clinical and endoscopic control of the disease, with an IHB of 1 point and no anastomotic recurrence. Crohn's Disease, by its transmural nature, combined with the variability in the distribution of the affected intestinal segment, can lead to fistula formation, with the most common types being enterovesical, enterocutaneous, enterovaginal, and enteroenteric. In the case described, a spinal fistula was observed, requiring urgent surgical intervention due to intense pain, sepsis, impaired lower limb mobility, and risk of meningitis. This case highlights the potential complications caused by fistulas in CD, presenting atypically with diagnostic complexity that may resemble extra-intestinal symptoms, requiring the medical team to have a high level of suspicion and experience in managing CD and using anti-TNF agents for disease control.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025