Gastroduodenal fistulas in Crohn's disease

Abstract

PURPOSE: The aim of this study was to assess the clinical features and management of fistulas involving the stomach and duodenum (gastroduodenal fistulas) in patients with Crohn's disease. METHODS: The medical records of 14 patients with a gastroduodenal fistula complicating Crohn's disease treated in this unit between 1958 and 1997 were reviewed. RESULTS: In six patients a gastroduodenal fistula was diagnosed before surgery, whereas eight gastroduodenal fistulas were discovered during surgery for distal Crohn's disease. In six patients, the fistula originated from Crohn's disease in the transverse colon, and in six patients, it originated from a recurrent disease at an ileocolonic anastomosis; these patients had no gross evidence of gastroduodenal Crohn's disease. In one patient, the ileocolonic-duodenal fistula closed on medical treatment. The other 11 patients underwent resection of the diseased bowel and closure of the gastric or duodenal fistulas. The two remaining fistulas were from the duodenum to the abdominal wall; both had primary Crohn's duodenitis. One duodenocutaneous fistula was treated by debridement of the duodenal fistula and simple closure of the defect; the other was treated by limited duodenal excision around the fistula and by duodenojejunostomy. In all patients, gastroduodenal fistulas were cured, and there have been no fistula recurrences. CONCLUSIONS: Simple closure of the gastroduodenal component of the fistula is generally advised for gastroduodenal fistulas. However, when the duodenal defect after excision around the fistula is large, duodenojejunostomy is recommended, provided there is no evidence of jejunal Crohn's disease.