Primary Coloduodenal Fistula in a Patient with Crohn's Disease

El-Hajj, Ihab; Abdul‐Baki, Heitham; El-Zahabi, Lara M.; Barada, Kassem

doi:10.1007/s10620-006-9227-9

Cited by 17 publications

(21 citation statements)

References 24 publications

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“…Reports of the surgical management of patients with GSD-1b complicated by colitis and coloduodenal fistula are rare and mostly case reports[ 4 , 11 ]. For our patient, we performed primary excision of the coloduodenal fistula followed by primary repair of the duodenal defect.…”

Section: Discussionmentioning

confidence: 99%

Rare complication of inflammatory bowel disease-like colitis from glycogen storage disease type 1b and its surgical management: A case report

Lui¹,

Lo²

2021

WJCC

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BACKGROUND Glycogen storage disease (GSD) is an autosomal recessive inborn metabolic disorder. Patients with GSD are prone to hypoglycaemia, hyperlactacidemia and bleeding. GSD type 1b (GSD-1b) patients specifically can develop neutropenia, recurrent bacterial infection and inflammatory bowel disease (IBD). Documentation of the long-term outcomes of surgical management of GSD-1b has been scarce, especially for Asian patients. We herein describe a case of GSD-1b complicated by IBD-like colitis and coloduodenal fistula. The patient was managed successfully with surgical intervention. CASE SUMMARY A 20-year-old Chinese lady confirmed by genetic testing to have GSD-1b was initially managed with uncooked cornstarch and granulocyte-colony stimulating factor. With recurrent abdominal symptoms, her condition was treated as clinical “Crohn’s disease” with mesalazine, prednisolone and azathioprine conservatively. Colonoscopy showed a tight stricture at the hepatic flexure. Subsequent computerized tomographic colonography revealed a phlegmon at the ileocaecal region with a suspected coloduodenal fistula. Eventually an exploratory laparotomy was performed and severe colitis at the ascending colon with coloduodenal fistula was confirmed. Right hemicolectomy with primary anastomosis and repair of the duodenum were performed. Surgical management of complications from GSD-1b associated IBD-like colitis has rarely been described. First-line treatment would usually be conservative. Surgical intervention like hemicolectomy is mainly reserved for refractory cases. CONCLUSION Surgical management of coloduodenal fistula in GSD-1b patients is a feasible and safe option when failed conservative management.

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Section: Discussionmentioning

confidence: 99%

Rare complication of inflammatory bowel disease-like colitis from glycogen storage disease type 1b and its surgical management: A case report

Lui¹,

Lo²

2021

WJCC

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“…In most cases the fistulas arise from the diseased small or large bowel. Pain located in the epigastrium in association with nausea and vomiting are the most common symptoms, while fecal vomiting is rare [3,6,7]. Contrast imaging studies (barium enema or meal and small bowel series) and endoscopy are the most useful procedures for the diagnosis and evaluation of the fistulas [7].…”

Section: Discussionmentioning

confidence: 99%

“…Resection of the diseased segment of the bowel containing the fistula (primary site of the disease), resection of the fistula and primary repair of the affected organ, has been proven so far to be the most effective treatment method of intra-abdominal fistulas and numerous operative approaches have been suggested [3,6,10,14]. In our patient right hemi-colectomy with ileo-transverse anastomosis, drainage of the abdominal abscess and primary closure of the upper GI tract openings (gastric, duodenal and jejunal) were performed at one stage operation, without postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous occurrence of hyperthyroidism and fistulizing Crohn's disease complicated with intra-abdominal fistulas and abscess: a case report and review of the literature

Pachiadakis

Nakos

Tatsi

et al. 2009

Cases J

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IntroductionFistula formation in patients with Crohn’s disease is a common complication during the course of the disease. Perianal and enteroenteric are the most common forms of fistulas, whereas the involvement of the upper gastrointestinal tract with gastrocolic and duodenocolic fistulas represents an extremely unusual condition. Moreover, hyperthyroidism in association with Crohn’s disease has been rarely described.Case presentationWe present here a rare case of a 25-year-old male with simultaneous onset of hyperthyroidism and fistulizing Crohn’s disease. Crohn’s disease was complicated with intra-abdominal fistulas involving the upper gastrointestinal tract (duodenocolic, gastrocolic) and an intra-peritoneal abscess formation in the lesser sac. We describe the clinical presentation and therapeutic management of the patient including both medical treatment and surgical intervention. Despite intense medical treatment with total parenteral nutrition, antibiotics, aminosalicylates and corticosteroids the clinical course of the disease was suboptimal. Finally, the patient underwent laparotomy and right hemi-colectomy with ileo-transverse anastomosis performed, with simultaneous drainage of the abdominal abscess and primary closure of the upper gastrointestinal tract openings (gastric, duodenal and jejunal) at one stage operation. Although the surgical approach definitively cured the perforating complications of the disease (fistulas and abscess), the luminal disease in the colon remnant was still active and steroid-refractory. The subsequent successful treatment with infliximab, azathioprine and mesalazine resulted in the induction and maintenance of the disease remission. Thyrotoxicosis was successfully treated with methimazole and the hyperthyroidism has definitely subsided.ConclusionThe management of intra-abdominal fistulas in Crohn’s disease is a complex issue, requiring a multi-disciplinary approach and ‘tailoring’ of the treatment to the individual patient’s needs. Probably, a sensible approach involves early surgical intervention with prior optimization of the patient’s general condition when feasible. Common autoimmune mechanisms are probably involved in thyroid dysfunction associated with Crohn’s disease. Moreover, diagnosis and treatment of coexisting thyroid disorder in patients with Crohn’s disease has a favorable impact in disease prognosis.

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“…The occurrence of stenosis and deformity of the stomach and duodenum could be observed in the late stage of CD and it can lead to gastrointestinal tract obstruction [9]. Duodenal fistulas are very rare [9], although El-Hajj II et al reported a case of primary duodeno-colic fistula, surgically treated, due to CD [26].…”

Section: Leki Stosowane W Terapii Choroby Leśniowskiego-crohnamentioning

confidence: 99%

Crohn’s disease in the upper gastrointestinal tract. Own experience and review of the literature

Reszczyńska¹,

Poniewierka²,

Waśko−Czopnik³

et al. 2011

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Primary Coloduodenal Fistula in a Patient with Crohn's Disease

Cited by 17 publications

References 24 publications

Rare complication of inflammatory bowel disease-like colitis from glycogen storage disease type 1b and its surgical management: A case report

Rare complication of inflammatory bowel disease-like colitis from glycogen storage disease type 1b and its surgical management: A case report

Simultaneous occurrence of hyperthyroidism and fistulizing Crohn's disease complicated with intra-abdominal fistulas and abscess: a case report and review of the literature

Crohn’s disease in the upper gastrointestinal tract. Own experience and review of the literature

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