Clinical features and management of duodenal fistula in patients with Crohn's disease.

BACKGROUND/AIMS: Duodenal fistula is rare in patients with Crohn's disease and almost all patients require surgery. Generally surgery for duodenal CD and reconstruction is considered difficult. We reviewed the clinical features of duodenal fistula with CD and considered suitable preoperative treatments.

METHODOLOGY: We reviewed the records of 10 patients with duodenal fistula complicating CD between September 1974 and April 2009.

RESULTS

Mean age at surgery was 31.5 years (range 22-36). Mean duration from onset of CD or previous surgery was 49.8 months (range 1.5-172.6). All patients were treated with total parenteral nutrition before surgery, 3 patients with steroids and 1 patient with infliximab. Synergistic effects of these immunomodulators were not examined in this study. Although preoperative treatments improved the values of CD activity index (p<0.01) all patients required surgical treatment. Duodenal fistula in all patients resulted from intrinsic CD lesion at the colon or ileum. Although immunmodulators had no additional effects on shortening hospital stay or improving activity index, simple fistula repair was performed in all patients.

CONCLUSIONS

Although the additional effects of immunomodulators were not confirmed, the sufficient preoperative treatment for duodenal fistula with CD to reduce disease activity seems likely to facilitate subsequent minimal surgery.