title: Unusual case of duodenobiliary fistula complicating Crohn's disease successfully treated with Adalimumab.
abstract: Crohn's disease (CD) is characterized by transmural inflammation of the gastrointestinal tract, which predisposes to the formation of fistula. Duodenal involvement occurs in less than 5% of cases and often leads to clinically relevant strictures. However, fistula formation in the duodenum is exceptional. Herein, we report an unusual case of duodenobiliary fistula due to CD occurring in a 65-year-old patient who was successfully treated by anti-tumor necrosis factor (TNF) agents. This case report highlights the efficacy of anti-TNF alpha agents in the treatment of a bilioenteric fistula because it increases the probability of clinical remission and mucosal healing and therefore reduces the need for surgical treatment which may be associated morbidity.
authors.affiliation: Department of Gastroenterology, University Hospital of Sahloul, Tunisia. Electronic address: aya_med@hotmail.fr.
authors.forename: Aya
authors.initials: A
authors.lastname: Hammami
authors.affiliation: Department of Gastroenterology, University Hospital of Sahloul, Tunisia.
authors.forename: Aida Ben
authors.initials: AB
authors.lastname: Slama
authors.affiliation: Department of Gastroenterology, University Hospital of Sahloul, Tunisia.
authors.forename: Hanen
authors.initials: H
authors.lastname: Jaziri
authors.affiliation: Department of Gastroenterology, University Hospital of Sahloul, Tunisia.
authors.forename: Wafa Ben
authors.initials: WB
authors.lastname: Ameur
authors.affiliation: Department of Gastroenterology, University Hospital of Sahloul, Tunisia.
authors.forename: Imed Ben
authors.initials: IB
authors.lastname: Mansour
authors.affiliation: Department of Gastroenterology, University Hospital of Sahloul, Tunisia.
authors.forename: Ahlem
authors.initials: A
authors.lastname: Brahem
authors.affiliation: Department of Gastroenterology, University Hospital of Sahloul, Tunisia.
authors.forename: Salem
authors.initials: S
authors.lastname: Ajmi
authors.affiliation: Department of Radiology, University Hospital of Sahloul, Tunisia.
authors.forename: Hela
authors.initials: H
authors.lastname: Jemni
authors.affiliation: Department of Gastroenterology, University Hospital of Sahloul, Tunisia.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ksiaa
authors.affiliation: Department of Gastroenterology, University Hospital of Sahloul, Tunisia.
authors.forename: Ali
authors.initials: A
authors.lastname: Jmaa
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001649:Bile Duct Diseases / Q000150:complications* / Q000188:drug therapy; D001658:Biliary Fistula / Q000150:complications* / Q000188:drug therapy; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy*; D004378:Duodenal Diseases / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D000068879:Adalimumab
keywords: Anti-TNF agents; Crohn’s disease; Duodenobiliary fistula; Duodenum stricture; Transmural inflammation