title: Coloduodenal and enterocutaneous fistula in twins with Crohn´s disease.
abstract: We present the case of a pair of 45-year-old monozygotic twins (A and B) diagnosed with Crohn's disease (CD) at age 20 (A) and 22 (B) with similar presenting symptoms: diarrhea, fever and weight loss. Both of them had duodenal and ileocolonic disease (A2, L3+L4 according to Montreal classification); twin B also presented jejunal involvement and perianal disease (B1p). They received treatment with antibiotics, corticosteroids, 5-ASA, azathioprine and anti-TNF with a poor control of activity. They both developed a coloduodenal fistula that required surgery. Twin A developed the fistula 12 years after the first presentation; fistula closure with duodenorraphy and ileocolonic resection with gastrojejunostomy was performed. Twin B developed the fistula 22 years after the first presentation, and right colectomy, partial duodenectomy and duodenorraphy was carried out. Both developed an enterocutaneous fistula during the postoperative period. With intensive medical treatment, both twins remain asymptomatic.
authors.affiliation: Gastroenterología y Hepatología, Hospital Clínico Universitario Valencia, España.
authors.forename: Maíia Pilar
authors.initials: MP
authors.lastname: Ballester
authors.affiliation: Gastroenterología y Hepatología, Hospital Clínico Universitario Valencia, España.
authors.forename: David
authors.initials: D
authors.lastname: Martí
authors.affiliation: Gastroenterología y Hepatología, Hospital Clínico Universitario de Valencia, España.
authors.forename: Marta Maia
authors.initials: MM
authors.lastname: Boscá Watts
authors.affiliation: Cirugía General, Hospital Clínico Universitario Valencia, España.
authors.forename: José
authors.initials: J
authors.lastname: Martín Arévalo
authors.affiliation: Gastroenterología y Hepatología, Hospital Clínico Universitario Valencia, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mínguez
mesh_terms: D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000000981:diagnostic imaging*; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging*; D016154:Digestive System Fistula / Q000150:complications / Q000000981:diagnostic imaging*; D004378:Duodenal Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging*; D008875:Middle Aged; D014430:Twins, Monozygotic