Abstract
The posterior surface of the proximal transverse colon and the anterior surface of the descending duodenum are intimately related, predisposing to fistulization in this area. We herein describe a rare case of benign duodenocolic fistula secondary to Crohn's disease. We emphasize the clinical presentation with fecaloid vomiting, as well as the establishment of the diagnosis by endoscopy, which are both extremely rare. The presence of a colonic stricture supports the hypothesis that the disease started in the colon rather than in the duodenum, and mandates surgical rather than medical therapy. Our case illustrates the possibility of coloduodenal fistula in patients with long-standing Crohn's disease, which should be considered in patients presenting with fecaloid vomiting, abdominal pain, and weight loss.
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References
Pichney LS, Fantry GT, Graham SM (1992) Gastrocolic and duodenocolic fistulas in Crohn's disease. J Clin Gastroenterol 15:205–211
Masters H (1948) Duodenal-colic fistula as a complication of regional ileitis. J Mt Sinai Hosp 15:264–265
Ransom HK (1945) Gastrojejunocolic fistulas. Surgery 18:177–190
Grayson MJ, O’Connell ND (1960) Benign duodeno-colic fistulae. Postgrad Med J 36:549–556
Coghill NF (1961) A case of Crohn's disease. Br Med J 1:1227–1231
Leichtling JJ, Garlock JH (1960) Granulomatous colitis complicated by gastrocolic, duodenocolic, and colopulmonic fistulas. AJR 83:876–881
Nelson SW (1969) Some interesting and unusual manifestations of Crohn's disease (“regional enteritis”) of the stomach, duodenum, and small intestine. AJR 107:86–101
Holzbach RT, Jones JC (1969) Severe regional enteritis with a unique duodenosigmoid fistula following normal pregnancy. Am J Gastroenterol 53:48–55
Thompson WH, Cockrill H, Rice RP (1985) Regional enteritis of the duodenum. AJR 123:252–261
Smith TR, Goldin RR (1977) Radiographic and clinical sequelae of the duodenocolic anatomic relationship: two cases of Crohn's disease with fistulization to the duodenum. Dis Colon Rectum 20:257–262
Wilk PJ, Fazio V, Turnbull RB (1977) The dilemma of Crohn's disease: ileoduodenal fistula complicating Crohn's disease. Dis Colon Rectum 20:387–392
Korelitz BI (1977) Colonic-duodenal fistula in Crohn's disease. Am J Dig Dis 22:1040–1048
Fitzgibbons TJ, Green G, Silberman H, Eliasoph J, Halls JM, Yellin AE (1980) Management of Crohn's disease involving the duodenum, including duodenal cutaneous fistula. Arch Surg 115:1022–1028
Goldwasser B, Mazor A, Wiznitzer T (1981) Enteroduodenal fistulas in Crohn's disease. Dis Colon Rectum 24:485–486
Broe PJ, Bayless TM, Cameron JL (1982) Crohn's disease: are enteroenteral fistulas an indication for surgery? Surgery 91:249–253
Mosca F, Della Giovampaola C, Parra PF, D’Elia F, Cei A (1984) Enterocolite granulomatosa e fistula colo-duodenale. Minerva Chir 39:1745–1749
Murray JJ, Schoetz DJ, Nugent FW, Coller JA, Veidenheimer MC (1984) Surgical management of Crohn's disease involving the duodenum. Am J Surg 147:58–65
Jacobson IM, Schapiro RH, Warshaw AL (1985) Gastric and duodenal fistulas in Crohn's disease. Gastroenterology 89:1347–1352
Glass RE, Ritchie JK, Lennard-Jones JE, Hawley PR, Todd IP (1985) Internal fistulas in Crohn's disease. Dis Colon Rectum 28:557–561
Klein S, Greenstein AJ, Sachar DB (1987) Duodenal fistulas in Crohn's disease. J Clin Gastroenterol 9:46–49
Lee KKW, Schraut WH (1989) Diagnosis and treatment of duodenoenteric fistulas complicating Crohn's disease. Arch Surg 124:712–715
Dey KR, Latchmore AJC (1970) Steatorrhoea due to duodeno-colic fistulae from perforation of a duodenal diverticulum with ectopic gastric epithelium. Br J Clin Pract 24:444–445
Hughes S, Marsh MN (1983) Fistulating duodenal diverticulum with associated vitamin B12 deficiency. Postgrad Med J 59:536–538
Halligan EJ, Perkel LL, Catlaw (1995) Duodenocolic fistula. Am J Proctol 1:7–16
Benn M, Nielsen FT, Antonsen HK (1977) Benign duodenocolic fistula. A case presenting with acidosis. Dig Dis Sci 42:345–347
Lichtenstein GR (2000) Treatment of fistulizing Crohn's disease. Gastroenterology 119:1132–1147
Egan LJ, Sandborn WJ, Tremaine WJ (1998) Clinical outcome following treatment of refractory inflammatory and fistulizing Crohn's disease with intravenous cyclosporine. Am J Gastroenterol 93:442–448
Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA, Podolsky DK, Sands BE, Braakman T, DeWoody KL, Schaible TF, van Deventer SJ (1999) Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 340:1398–1405
Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, Kamm MA, Korzenik JR, Lashner BA, Onken JE, Rachmilewitz D, Rutgeerts P, Wild G, Wolf DC, Marsters PA, Travers PA, Blank MA, van Deventer SJ (2004) Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med 350:876–885
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El-Hajj, I.I., Abdul-Baki, H., El-Zahabi, L.M. et al. Primary Coloduodenal Fistula in a Patient with Crohn's Disease. Dig Dis Sci 52, 59–63 (2007). https://doi.org/10.1007/s10620-006-9227-9
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DOI: https://doi.org/10.1007/s10620-006-9227-9