Abstract
PURPOSE: This study was designed to assess clinical and pathologic features of duodenal Crohn's disease (CD) and address its management according to different patterns of disease. METHODS: Twelve cases of duodenal involvement in CD are reported out of 336 patients treated between 1978 and 1993. They represent 3.6 percent of all cases. Three patients had a duodenal fistula, and nine had an intrinsic duodenal lesion. The duodenal fistula was in all cases a manifestation of recurrent CD involving an ileocolic anastomosis and the third portion of the duodenum. RESULTS: Treatment consisted of resection of the fistula's source and primary closure of duodenal breach. Of nine patients with intrinsic CD, five had stenosis and the remaining four had peptic ulcer-like lesions. Duodenal stenosis was treated with strictureplasty in three cases and duodenojejunostomy in two. No patient with ulcer-like lesions underwent surgery. CONCLUSIONS: Differences encountered in intrinsic duodenal lesions apparently reflect two different clinical patterns. Stenosis is not usually associated with multifocal disease and is often the first evidence of disease. Ulcer-like lesions are not specific; they do not evolve into stenosis as do ulcers in other sites of the disease, spontaneously disappear and relapse, and do not require surgery, except for complications. They are always associated with other locations of the disease.
Similar content being viewed by others
References
Nugent WF, Roy MZ. Duodenal Crohn's disease: an analysis of 89 cases. Am J Gastroenterol 1989;84:249–54.
Tootla F, Lucas RJ, Bernacki EG, Tabor H. Gastroduodenal Crohn's disease. Arch Surg 1976;111:855–7.
Sandler RS, Solden AL. Epidemiology of Crohn's disease. J Clin Gastroenterol 1986;8:160–5.
Farmer RG, Whelan G, Fazio VW. Long term follow up of patients with Crohn's disease: relationship between the clinical pattern and prognosis. Gastroenterology 1985;88:1818–25.
Lee EG, Papaioannou N. Minimal surgery for chronic obstruction in patients with extensive or universal Crohn's disease. Ann R Coll Surg Engl 1982;64:229–33.
Tucci A, Corinaldesi R, Stanghellini V,et al. Helicobacter pylori infection in patients with idiopathic dyspepsia. Gastroenterology 1992;83:1306–12.
Fielding JF, Toye DK, Beton DC, Cooke WT. Crohn's disease of the stomach and duodenum. Gut 1970;11:1001–6.
Farmer RG, Hawk WA, Turnbull RB Jr. Crohn's disease of the duodenum (transmural duodenitis): clinical manifestations and report of 11 cases. Am J Dig Dis 1972;17:191–8.
Fitzgibbons TJ, Green G, Silberman H, Eliajoph J, Halls JM, Yellin AE. Management of Crohn's disease involving the duodenum including duodenal cutaneous fistula. Arch Surg 1980;115:1022–8.
Katz J, Talansky A, Kahn E. Recurrent free perforation of gastroduodenal Crohn's disease. Am J Gastroenterol 1983;78:722–5.
Simmonds SD, Pitman RG, Machan L, Halparin LS. Duodenopancreatic fistula accompanying Crohn's disease of the distal duodenum. Am J Gastroenterol 1989;48:800–3.
Lee KK, Shrant WH. Diagnosis and treatment of duodenoenteric fistulas complicating Crohn's disease. Arch Surg 1989;124:712–5.
Murray JJ, Schoetz DJ Jr, Nugent FW, Coller JA, Veidenheimer MC. Surgical management of Crohn's disease involving the duodenum. Am J Surg 1984;147:58–65.
Wilk PJ, Fazio VW, Turnbull RB. The dilemma of Crohn's Disease: ileoduodenal fistula complicating Crohn's disease. Dis Colon Rectum 1977;20:387–92.
Rutgeerts P, Onette E, Vantrappen G, Geboes K, Broeckaert L. Crohn's disease of the stomach and the duodenum: a clinical study with emphasis on the value of endoscopy and endoscopic biopsies. Endoscopy 1980;12:288–94.
Danzi JT, Farmer RG, Sullivan BH, Rankin GB. Endoscopic features of gastroduodenal Crohn's disease. Gastroenterology 1976;70:9–13.
Alcàntara M, Rodriguez R, Potenciano JL, Carrobles JL, Muñoz C, Gomez R. Endoscopic and bioptic findings in the upper gastrointestinal tract in patients with Crohn's disease. Endoscopy 1993;25:282–6.
Ruuska T, Vaajalahti P, Arajärvy P, Mäki P. Prospective evaluation of upper gastrointestinal mucosal lesion in children with ulcerative colitis and Crohn's disease. J Pediatr Gastroenterol Nutr 1994;19:181–6.
Cameron DJ. Upper and lower gastrointestinal endoscopy in children and adolescents with Crohn's disease. J Gastroenterol Hepatol 1991;6:355–8.
Lenaerts C, Roy CC, Vaillancourt M, Weber AM, Morin CL, Seidman E. High incidence of upper gastrointestinal tract involvement in children with Crohn's disease. Pediatrics 1989;83:777–81.
Alexander-Williams J. Maladie de Crohn de l'intestine grêle. Chirurgie (Memoires de l'Académie) 1980;116:45–52.
Wise L, Kyriaxos M, McCown A, Ballinger WL. Crohn's disease of the duodenum: a report and analysis of eleven new cases. Am J Surg 1971;121:184–94.
Francoys Y, Castagnola C, Descos L, Vignal J. Maladie de Crohn duodénale: problémes thérapeutiques. Lyon Chir 1990;86:391–2.
Ross TM, Fazio VW, Farmer RG. Long term results of surgical treatment for Crohn's disease of the duodenum. Ann Surg 1983;197:399–406.
Kim US, Zimmerman MJ, Weiss M. Massive upper gastrointestinal hemorrage associated with Crohn's disease of the stomach and duodenum. Am J Gastroenterol 1973;59:244–9.
Paget ET, Owens MP, Peniston WO. Massive upper gastrointestinal tract hemorrage: a manifestation of regional enteritis of the duodenum. Arch Surg 1972;104:397–400.
Author information
Authors and Affiliations
About this article
Cite this article
Poggioli, G., Stocchi, L., Laureti, S. et al. Duodenal involvement of Crohn's disease. Dis Colon Rectum 40, 179–183 (1997). https://doi.org/10.1007/BF02054984
Issue Date:
DOI: https://doi.org/10.1007/BF02054984