Successful resection of a duodenal fistula complicated with recurrent Crohn's disease at the site of previous ileocolonic anastomosis: report of a case.
A duodenal fistula complicated with Crohn's disease may present a difficult management problem. We herein report the case of a 22-year-old woman who developed a colo-ileo-duodenocutaneous fistula with recurrent disease at the ileotransverse anastomosis. The patient had previously undergone an ileoascending colectomy for Crohn's disease. Preoperative colonoscopy did not reveal any evidence of intrinsic duodenal Crohn's disease. Symptomatology was obstructive and a consequence of associated ileocolic lesions. The patient underwent a resection of the diseased bowel including the duodenal component of the fistula. Surgery included a simple closure of the duodenal defect with both omental pedicle graft wrapping and decompression of the duodenum via a gastrostomy tube. The patient had an uneventful postoperative course. The duodenal fistula was successfully cured. Our experience demonstrates that duodenal fistulas may be successfully treated when the duodenum is not involved with intrinsic Crohn's disease. Such treatment consists of a resection of the diseased bowel segment and a primary simple closure of the duodenal defect.
D000328:Adult; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery; D003424:Crohn Disease / Q000150:complications*; D017577:Cutaneous Fistula / Q000150:complications* / Q000601:surgery; D004378:Duodenal Diseases / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007412:Intestinal Fistula / Q000150:complications* / Q000601:surgery; D012008:Recurrence