[Acute pancreatitis and duodenobiliary fistula--a rare complication of Crohn's disease].
METHODS
A 53-year-old man with long-standing Crohn's disease presented with recurrent abdominal pain and vomiting; lipase levels were elevated.


METHODS
At admission ultrasound demonstrated a swollen head of the pancreas, dilated pancreatic and intrahepatic bile ducts and peripancreatic fluid. At upper gastrointestinal endoscopy a 10 mm bleeding ulcer was identified, which histologically proved to be epitheloid cell-containing granulomas. A fistula connecting to the hepatocholedochal duct was identified at the floor of the ulcer. Helicobacter pylori was not demonstrated.


METHODS
After sphincterotomy of the papilla of Vater concrements were extracted and a stent was implanted into the common bile duct. Ultimately a total of five stents were consecutively implanted via the major papilla, closing the fistula. After three years all stents were removed and pancreatitis did not recur.


CONCLUSIONS
The differential diagnosis of abdominal pain in patients with Crohn's disease is often difficult and should include fistulas of the upper gastrointestinal tract which may be treated endoscopically.
Grabig
A
A
Medizinische Klinik m.S. Hepatologie und Gastroenterologie, Charité--Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany.
Veltzke-Schlieker
W
W
Sturm
A
A
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D003424:Crohn Disease / Q000150:complications*; D003937:Diagnosis, Differential; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016145:Endoscopy, Digestive System; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D014839:Vomiting / Q000209:etiology