title: Successful management of a colo-duodenal fistula in a patient with Crohn's disease using a double lumen gastro-jejunostomy tube.
abstract: A 41-year-old woman was admitted with upper abdominal pain, vomiting and fever. Abdominal CT scan showed a colo-duodenal fistula with inflammatory thickening of the transverse colon. The patient's general health was poor because of hypoalbuminemia and coagulopathy. Endoscopy showed a fistula at the lower duodenal angle and the stomach was filled with refluxed stool. Ileostomy and percutaneous endoscopic gastrostomy were performed at that time and a double lumen gastro-jejunostomy inserted through the gastrostomy to allow both gastric drainage and distal enteral feeding. Nutrition support was gradually converted from parenteral to enteral feeding. Colonoscopy showed stenosis of the transverse colon with a colo-colonic fistula near the stenosis. Two months later, right hemi-colectomy and closure of the colo-duodenal fistula were performed. The resected specimen showed stenosis and a fistula in the transverse colon due to Crohn's disease. The colo-colonic fistula was present and the colo-duodenal fistula had almost closed due to fibrosis. The postoperative course was uneventful and the patient was discharged after administration of infliximab. Use of a double lumen gastro-jejunostomy tube was effective in improving the patient's general condition. This therapeutic strategy allowed the safe conduct of major resection in a high-risk patient.
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Zuiki
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Meguro
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kumano
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Koinuma
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Miyakura
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Hisanaga
authors.initials: H
authors.lastname: Horie
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Lefor
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Sata
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke City, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
keywords: Double lumen gastro-jejunostomy tube; Percutaneous endoscopic gastrostomy; Right hemi-colectomy