BACKGROUND
Fistulas involving the stomach and duodenum in
Crohn's disease are rare (occurring in less than 1% of patients). Here, we reviewed registers from 855 patients with
Crohn's disease treated in our service from January 2007 to December 2020 and found 4 cases of duodenal
fistula and 1 case of
gastric fistula. CASE REPORT The
fistula origin was in the ileocolic segment in all cases, and all of the patients underwent preoperative optimization with improvement of nutritional status and infection control. They then underwent surgical treatment with resection of the affected segment and duodenal or gastric closure with covering by an omental patch. One case of a duodenal
fistula was complicated by duodenal dehiscence. This was treated surgically with duodenojejunostomy. Each of the other patients had an uneventful postoperative course. All patients were successfully cured of their gastroduodenal
fistulas, and at the time of this publication, none of them died or had
fistula recurrence. CONCLUSIONS
Fistulas with the involvement of the stomach and duodenum in patients with
Crohn's disease are almost always due to
inflammation in the ileum, colon, or previous ileocolic anastomosis. Management of this situation is complex and often requires clinical and surgical assistance; preoperative optimization of the patient's general condition can improve the surgical results. The surgical approach is based on resection of the affected segment and gastric or duodenal closure with covering by an omental patch.
Gastrojejunostomy or duodenojejunostomy can be performed in selected patients with larger defects and minor
jejunal disease. To prevent recurrence, prophylactic
therapy with anti-TNF agents and early endoscopic surveillance are also essential for successful treatment.