Duodenopancreatic fistula accompanying Crohn's disease of the distal duodenum.

A 47-yr-old male with known Crohn's disease involving the third and fourth part of the duodenum and terminal ileum presented to hospital with nausea and vomiting due to duodenal obstruction. An upper gastrointestinal series revealed a clinically unsuspected fistula joining the duodenum and pancreatic duct. He subsequently underwent vagotomy and gastroenterostomy to bypass the obstructed segment of duodenum. The duodenopancreatic fistula was not disturbed. Post-operatively, his symptoms resolved, he gained 30 pounds of weight, and manifested no ill effect secondary to the fistula. A repeat upper gastrointestinal series 9 months postoperatively revealed the fistula to have closed, although marked duodenal narrowing remained.