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The treatment of patients with Crohn's disease (CD) presenting intestinal fistulas is debated. A retrospective analysis was made of the treatment of 26 patients with Crohn's disease who had a total of 37 fistulas: 28 internal and 9 external. In 19 patients the fistulas were single and in 7 multiple; in most patients the fistula originated on the terminal ileum. Crohn's disease was ileal in 10 patients, ileocolonic in 15 and exclusively colonic in 1, and the evolution of the disease from the onset of symptoms to the appearance of the fistula was a mean of 5.8 years. The diagnosis, except for two patients in whom it was an operative finding, was based on the clinical examination and radiology studies. All the patients, except for four with asymptomatic internal fistulas, underwent medical treatment as needed. Six patients required only medical treatment, and the rest, 16, received medical and surgical treatment. Surgical treatment consisted basically of resection of the intestinal segment affected by the fistula, with or without anastomosis. The operative mortality was 0% and the morbidity was 25%, the most frequent complication being infection of the surgical wound. All the patients with external fistulas required surgical treatment. In every case the fistula was single. The treatment of internal fistulas in conditioned by the symptoms the response to medical treatment and the presence or not of associated pathology. Asymptomatic patients or those who responded to medical treatment had single fistulas.

A study was made of the histologic changes in the mucosa of the ileoanal reservoirs of 10 patients who 2 years earlier had undergone ileoanal anastomosis with a J reservoir for ulcerative colitis (CU). In biopsies of the reservoirs were evaluated: 1) basic morphologic changes; 2) morphometric differences with respect to normal ileal mucosa; 3) the immunohistochemical pattern (IHQ) (IgA, IgG, IgM and CEA) of the reservoir mucosa as compared to normal ileum, active ulcerative colitis. Crohn's disease and celiaca; 4) the possible existence of atypias or dysplasias of the reservoir mucosa; and 5) the number of argentaffin cells per field. The basic morphologic alteration consisted of colonic metaplasia. Reservoir biopsies exhibited partial (8 cases) or subtotal atrophy (2 cases) of the mucosa. With respect to the normal ileum there was a decrease in villi height (p less than 0.05), an increase in crypt depth (p less than 0.05) and a higher index of mucosal regeneration, with a larger number of cells and mitoses per crypt (p less than 0.05). Fifty percent of the reservoirs presented a chronic inflammatory pattern with an acute component in 30% of them. The immunohistochemical pattern of the reservoirs not inflamed was similar to that of normal ileum (IgA much greater than IgM greater than IgG) and that of the inflamed reservoirs was similar to that of intestinal inflammatory disease (marked increase in the IgG. CEA (similar to what?) an alteration of local immune homeostasis could have of the genesis of pictures of "pouchitis". No alarming signs of atypia or dysplasia were found, nor changes in the population of argentaffin cells.