The dilemma of Crohn's disease

Wilk, Peter J.; Fazio, Victor W.; Turnbull, Rupert B.

doi:10.1007/bf02587367

Cited by 35 publications

(9 citation statements)

References 3 publications

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“…The current study investigated clinical characteristics, surgical management, and operative outcomes of patients with upper GI CD. Previous retrospective studies showed a prevalence of 0.3%– 5% [ 7 , 9 - 13 ], while the few prospective studies to analyze CD presentation after esophagogastroduodenoscopy in upper GI CD have suggested a prevalence of 24% to 56% [ 17 , 18 ]. We found the prevalence of upper GI CD to be 2.96%, in line with other retrospective studies that reported using surgical data [ 10 - 13 ] and endoscopic data [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most common CD site is the terminal ileum with or without the ileocecal valve, cecum, or proximal ascending colon [ 3 , 4 ], while involvement of the upper GI tract, stomach, and duodenum is rare [ 5 - 7 ]. Since the first reported case of upper GI tract involvement by Gottlieb [ 8 ] in 1937, upper GI CD has only been found in 0.3%–5% of patients with CD [ 7 , 9 - 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease

Moon

Lee

et al. 2020

Ann Coloproctol

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Purpose: Upper gastrointestinal (GI) tract involvement in Crohn disease (CD) is rare and effectiveness of surgical treatment is limited. The aim of this study was to evaluate characteristics and surgical outcomes of upper GI CD.Methods: Medical records of 811 patients who underwent intestinal surgery for CD between January 2006 and December 2015 at a single institution were reviewed. Upper GI CD was defined by involvement of the stomach to the fourth portion of duodenum, with or without concomitant small/large bowel CD involvement according to a modification of the Montreal classification.Results: We identified 24 patients (21 males, 3 females) who underwent surgery for upper GI CD. The mean age at diagnosis was 27 ± 12 years, the mean age at surgery was 33 ± 11 years, and the mean duration of CD was 73.6 ± 56.6 months. Fifteen patients (62.5%) had history of previous perianal surgery. Ten patients (41.7%) had duodenal or gastric stricture and 14 patients (58.3%) had penetrating fistula; patients with fistula were significantly more likely to develop complications (57.1% vs. 20.0%, P = 0.035). One patient with stricture had surgical recurrence. In seven patients with fistula, fistula was related to previous anastomosis. Patients with fistula had significantly longer hospital stays than those with stricture (16 days vs. 11 days, P = 0.01).Conclusion: Upper GI CD is rare among CD types (2.96%). In patients with upper GI CD, penetrating fistula was associated with longer hospital stay and more complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease

Moon

Lee

et al. 2020

Ann Coloproctol

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“…There is concern about leakage at the site of anastomosis in the duodenum and refistulization. In patients with a large defect in the duodenal wall after resection of the fistula, reconstruction of the duodeno-jejunal anastomosis has been reported [7]. Rutgeerts et al [8] reported that the ileocolic anastomosis caused stenosis in 72% of patients after curative surgery.…”

Section: Discussionmentioning

confidence: 99%

“…At the time of reconstruction, a functional end-to-end anastomosis was performed. Since recurrent fistulization has been reported in up to 30% of patients after surgery, omental interposition was used to protect against this complication [4, 6, 7]. …”

Section: Discussionmentioning

confidence: 99%

Successful Management of a Colo-Duodenal Fistula in a Patient with Crohn's Disease Using a Double Lumen Gastro-Jejunostomy Tube

Zuiki

Meguro

Kumano

et al. 2014

Case Rep Gastroenterol

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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.

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“…Wilk et al (15) emphasized that ileotransverse anastomosis overlying the duodenum holds a high risk for developing an ileocolonic-duodenal fistula.…”

Section: Most Of Enteroduodenal Fistulas Arise From the Recurrent Dismentioning

confidence: 99%

A rare complication of Crohn disease: Duodenocolic fistula

Bora¹,

Sonbahar²,

Özalp³

2017

Turk J Gastroenterol

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tween the third portion of duodenum and ileotransverse anastomosis (Figure 1). We also performed barium ABSTRACTCrohn disease (CD) is a chronic inflammatory disease that may be observed in random areas of gastrointestinal tract. Fistula formation is common during the course of CD, whereas duodenocolic fistulas are very rare. It is possible to safely perform surgical resection in patients who have severe symptoms of duodenal fistula. In this study, we report a rare case of CD with duodenocolic fistula that has emerged from the previous surgical resection.

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The dilemma of Crohn's disease

Cited by 35 publications

References 3 publications

Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease

Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease

Successful Management of a Colo-Duodenal Fistula in a Patient with Crohn's Disease Using a Double Lumen Gastro-Jejunostomy Tube

A rare complication of Crohn disease: Duodenocolic fistula

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