title: Clinical features and management of duodenal fistula in patients with Crohn's disease.
abstract: OBJECTIVE
  Duodenal fistula is rare in patients with Crohn's disease and almost all patients require surgery. Generally surgery for duodenal CD and reconstruction is considered difficult. We reviewed the clinical features of duodenal fistula with CD and considered suitable preoperative treatments.
  
  
  METHODS
  We reviewed the records of 10 patients with duodenal fistula complicating CD between September 1974 and April 2009.
  
  
  RESULTS
  Mean age at surgery was 31.5 years (range 22-36). Mean duration from onset of CD or previous surgery was 49.8 months (range 1.5-172.6). All patients were treated with total parenteral nutrition before surgery, 3 patients with steroids and 1 patient with infliximab. Synergistic effects of these immunomodulators were not examined in this study. Although preoperative treatments improved the values of CD activity index (p<0.01) all patients required surgical treatment. Duodenal fistula in all patients resulted from intrinsic CD lesion at the colon or ileum. Although immunmodulators had no additional effects on shortening hospital stay or improving activity index, simple fistula repair was performed in all patients.
  
  
  CONCLUSIONS
  Although the additional effects of immunomodulators were not confirmed, the sufficient preoperative treatment for duodenal fistula with CD to reduce disease activity seems likely to facilitate subsequent minimal surgery.
authors.affiliation: Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. motoi.uchino@nifty.ne.jp
authors.forename: Motoi
authors.initials: M
authors.lastname: Uchino
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takesue
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004378:Duodenal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007564:Japan; D008297:Male; D010289:Parenteral Nutrition, Total; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D013256:Steroids; D000069285:Infliximab