Successful treatment of an enterovesical fistula due to Crohn’s disease with stem cell transplantation: a case report

Crohn’s disease (CD) is a chronic, progressive inflammatory disease affecting the digestive tract. Up to 30% of patients develop a fistulising disease during their lifetime, leading to the development of a variety of fistulas between the gastrointestinal tract and nearby tissues, such as enterocutaneous, enterovesical or enterovaginal fistulas. Even in the era of biological agents, including anti-TNF drugs, approximately one-third of patients will suffer from fistulas that are chronic and resistant to standard treatments [1], which may lead to dangerous and life-threatening complications.
Recently, mesenchymal stem cells (MSC) were tested for the treatment of fistulising disease in phase II and phase III clinical trials [2–5]. Thanks to their high anti-inflammatory and regenerative potential, MSC exerted strong paracrine effects in perianal fistulas, producing positive effects [5]. However, in these trials, the regenerative cells were obtained from healthy donors. Among the various methods used to obtain stromal cells, the isolation of autologous adipose tissue-derived regenerative cells (ADRC) using the Celution system is one of the most novel and clinically applicable. Herein, we provide the first report of complete enterovesical fistula resolution following treatment with autologous ADRC.
A 52-year-old female who had been suffering from CD for 12 years was admitted to our clinic with a severe bacterial urinary tract infection. She had never attained clinical remission using steroids, immunosuppressants, anti-TNF agents with a short dosing interval, or alternative treatments such as cyclosporine, tacrolimus, or thalidomide. Consequently, she suffered from numerous complications, which led to a significant number of laparotomies. She had undergone multiple segmental resections of the small intestine and colectomy with ileostomy. Only maintenance therapy with adalimumab once a week with concomitant azathioprine resulted in a relative clinical remission. However, she still suffered from frequent perianal and peristomal fistulas, which led to several surgeries to reposition the stoma.
At the time of admission, the patient was suffering from pyrexia (up to 39°C) and dysuria; she also noted the passage of air and faeces during urination. The general state of the patient was critical because of severe undernutrition (BMI 15) and progressive urinary tract infection. A urine culture revealed severe polybacterial infection with Klebsiella...


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