Management of Crohn's disease involving the duodenum, including duodenal cutaneous fistula.

Crohn's disease involving the duodenum is rare and is usually associated with Crohn's disease elsewhere in the alimentary tract. Seven patients were treated at the Los Angeles County-University of Southern California Medical Center with complications of Crohn's disease involving the duodenum. These included two patients with abscess and duodenoileocolocutaneous fistulas, two with gastrointestinal tract bleeding, one with gastric outlet obstruction, and two with symptoms of small-bowel disease only. Four of the seven were successfully treated nonoperatively with a variety of modalities, including ulcer regimen, sulfasolazine, adrenocortical steroids, enteric rest, and total parenteral nutrition. Three patients required surgery, one for intractable bleeding and two for enterocutaneous fistulas. The majority of patients with duodenal Crohn's disease can be treated nonoperatively, with resolution of symptoms and roentgenographic healing of lesions. Surgical intervention is only advocated for those patients with complications that do not resolve with nonoperative therapy.