Surgical treatment for duodenal involvement in Crohn's disease: report of a case.
A 29-year-old woman was hospitalized with a 1-month history of postprandial epigastric pain, nausea, and vomiting. An upper gastrointestinal tract X-ray series showed a marked narrowing of the pyloric region. A histological examination of duodenal mucosal biopsy samples showed granulomatous inflammation, and thus a diagnosis of intrinsic duodenal Crohn's disease was made. A second upper gastrointestinal tract X-ray revealed a persistent gastric outlet obstruction. At laparotomy, the duodenal wall was found to be thickened over a distance measuring 3.5 cm in length from the pyloric ring. A longitudinal incision was made over the entire length, up to 5.5 cm beyond the pyloric ring on either side, while Finney-type anastomosis was also performed. A postoperative upper gastrointestinal tract X-ray showed an improvement in the gastroduodenal passage. Enteral nutrition therapy was provided postoperatively. Omeprazole was administered at a dose of 20 mg/day for 2 months. The patient currently remains on maintenance therapy with famotidine at 20 mg/day and is clinically doing well.
Takesue
Y
Y
First Department of Surgery, Hiroshima University School of Medicine, Japan.
Yokoyama
T
T
Kodama
T
T
Murakami
Y
Y
Imamura
Y
Y
Sasaki
S
S
Akagi
S
S
Matsuura
Y
Y
D000328:Adult; D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D004386:Duodenum / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D013536:Suture Techniques