Management of Crohn's Disease Involving the Duodenum, Including Duodenal Cutaneous Fistula

Fitzgibbons, Terrence J.; Green, Gerald; Silberman, Howard; Eliasoph, J; Halls, James M.; Yellin, Albert E.

doi:10.1001/archsurg.1980.01380090006003

Cited by 36 publications

(26 citation statements)

References 16 publications

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“…The development of coloduodenal fistulae in patients with Crohn's disease has been reported in 52 cases [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 1). We herein describe a case of primary coloduodenal fistula secondary to Crohn's disease, being particular for its clinical presentation and endoscopic documentation.…”

Section: Discussionmentioning

confidence: 99%

“…Initially, all fistulae were believed to arise in diseased ileum or colon and involve the duodenum secondarily. Although histologic evidence of primary gastric and duodenal disease is present in 6 cases [13,17,18], the interpretation must be tempered by the possibility that the disease may have gained access to the duodenum by direct extension from the colon. It is apparent in the majority of reported cases; fistulae nearly always arise from the small or large bowel in Crohn's disease.…”

Section: Discussionmentioning

confidence: 99%

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Primary Coloduodenal Fistula in a Patient with Crohn's Disease

et al. 2006

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The posterior surface of the proximal transverse colon and the anterior surface of the descending duodenum are intimately related, predisposing to fistulization in this area. We herein describe a rare case of benign duodenocolic fistula secondary to Crohn's disease. We emphasize the clinical presentation with fecaloid vomiting, as well as the establishment of the diagnosis by endoscopy, which are both extremely rare. The presence of a colonic stricture supports the hypothesis that the disease started in the colon rather than in the duodenum, and mandates surgical rather than medical therapy. Our case illustrates the possibility of coloduodenal fistula in patients with long-standing Crohn's disease, which should be considered in patients presenting with fecaloid vomiting, abdominal pain, and weight loss.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Primary Coloduodenal Fistula in a Patient with Crohn's Disease

et al. 2006

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“…Duodenal CD is rare, occurring in less than 2% of patients with CD. The initial manifestations of duodenal CD are nonspecific and may be similar to those of peptic ulcer disease (2), which may delay the correct diagnosis. Common bile duct obstruction as a complication of CD is unusual and rarely reported in the literature (11,12).…”

Section: Discussionmentioning

confidence: 99%

Ampullary Stenosis with Biliary Obstruction in Duodenal Crohn’s Disease: A Case Report and Review of the Literature

et al. 2005

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KEY WORDS: ampullary stenosis; biliary obstruction; duodenal Crohn's disease; review.Gastroduodenal involvement in Crohn's disease (CD) is rare, with a reported incidence ranging between 0.5 and 4.0% (1-6). Since Gottlieb and Alpert (7) described the first case in 1937, CD of the duodenum is being increasingly recognized. We report an unusual case of duodenal CD involving the major ampulla resulting in biliary obstruction. CASE REPORTA 24-year-old male was admitted for closure of a loop ileostomy. Three months earlier, he had undergone a total colectomy with an ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) refractory to medical therapy. UC was diagnosed in 1996 after the patient presented with bloody diarrhea. A colonoscopy shortly before the colectomy showed diffuse and continuous colitis from the rectum to the hepatic flexure. Biopsies revealed severe acute and chronic inflammation with gland branching and crypt abscesses consistent with chronic inflammatory bowel disease (IBD). No granulomas were seen. A UGI/SBFT follow-through was normal. The results of an IBD-antibody marker panel from Prometheus, Inc., San Diego, California ([+] PANCA and [−]ASC), were also suggestive of UC.Following the ileostomy closure, the patient developed sinus tachycardia and hypertension, with a heart rate in the 130s and a blood pressure of 200/100. Thyroid function tests were obtained. His thyroid stimulant hormone (TSH) was <0.01 µIU/ml (ref. range, 0.35-5.50 IU/ml) and his free thyroxine level (FT4) was 13.4 IU/ml (ref. range, 1.0-4.0 IU/ml), supporting a diagnosis Manuscript of hyperthyroidism. Therapy with methimazole and metoprolol, 25 mg po bid, was initiated. Several days after surgery, the patient developed postprandial right upper quadrant (RUQ) pain, nausea, and vomiting. Physical examination was significant for moderate RUQ tenderness without peritoneal signs. Further investigations included the following: total bilirubin, 1.6 mg/dl (ref. range, 0.3-1.2 mg/dl); serum aspartate aminotransferase, 231 U/L (ref. range, 5-40 U/L); serum alanine aminotransferase, 289 U/L (ref. range, 5-40 U/L); and alkaline phosphatase, 198 U/L (ref. range, 35-120 U/L).A RUQ ultrasound revealed a diffusely dilated common bile duct (CBD) measuring 1.3 cm in maximal diameter. The pancreatic duct also appeared prominent. The gallbladder was visualized without wall thickening, pericholecystic fluid, or gallstones. A subsequent MR cholangiopancreatogram (MRCP) confirmed the dilation of the CBD and showed a prominent pancreatic duct measuring 3-5 mm in maximum diameter. Soft tissue fullness was noted at the ampullary region, which was seen in all sequences and measured 7 × 6 mm in diameter, consistent with a prominent papilla. A small bowel through study showed an entirely normal course, caliber, and mucosal pattern.Endoscopic retrograde cholangiopancreatography (ERCP) was performed. Endoscopic views of the second and third portions of the duodenum revealed an abnormal granular appearance of the mucosa, with scattered superficial ...

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“…Duodenale Fisteln treten zumeist bei Patienten auf, die keinen duodenalen Befall des M. Crohn aufweisen [15,24] Der interessante Fall "133_00", 1.11.01/Mihr GmbH des Defektes im Bereich von Duodenum und Kolon [3,5,14,20]. In der Vergangenheit war von Wilk [26] …”

Section: Discussionunclassified

Duodenosigmoidale Fistel bei Morbus Crohn

Schadde

Schmidbauer²,

Heinzlmann³

et al. 2001

Zentralbl Chir

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The development of enteral fistulas - internal and external - is common in Crohn's disease with a frequency of about 45 % in large series of patients. Most internal fistulas arise in the small bowel, but internal large bowel fistulas occur in about one fourth of all patients with fistulas in Crohn's disease. Colonic gastroduodenal fistulas do occur, but are very rare. Of the 35 cases of colonic-duodenal fistulas that we found in the literature, most have been described to involve either a previous ileocolostomy site or the ascending or transverse colon. There are only three cases displaying sigmoidoduodenal fistulas. To these we add a fourth case with this report. A 42-year-old woman presented with upper abdominal pain, loss of appetite and regurgitations with a foul smell as well as abdominal gas complaints. A duodenosigmoidal fistula was diagnosed by local application of contrast and the fistula tract was excised in typical fashion by resection of the colonic fistula and primary closure of the duodenum. The patient experienced a good recovery with relief of symptoms.

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Management of Crohn's Disease Involving the Duodenum, Including Duodenal Cutaneous Fistula

Cited by 36 publications

References 16 publications

Primary Coloduodenal Fistula in a Patient with Crohn's Disease

Primary Coloduodenal Fistula in a Patient with Crohn's Disease

Ampullary Stenosis with Biliary Obstruction in Duodenal Crohn’s Disease: A Case Report and Review of the Literature

Duodenosigmoidale Fistel bei Morbus Crohn

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