Diagnosis and treatment of duodenoenteric fistulas complicating Crohn's disease.

A duodenoenteric fistula is an unusual complication of Crohn's disease that requires surgical intervention and may present a difficult management problem. Eleven patients with this condition were treated with an ileocolectomy with primary anastomosis and closure of the duodenal defect after take-down of the fistula. In all patients, the duodenal tissues were free of pathologic evidence of Crohn's disease. The fistula was found to result from Crohn's disease limited to the ileocolonic segment or from anastomotic complications in some patients who had previously undergone ileocolonic resections. Satisfactory healing at the ileocolonic anastomosis and at the duodenal closure site occurred in ten patients; breakdown of the duodenal closure leading to sepsis and death occurred in one patient with an unusually large defect in the first portion of the duodenum. In most instances, these fistulas can be treated safely and adequately by resection of the diseased intestinal segment and simple direct duodenal closure. However, safe management of large duodenal defects may require the use of other methods, such as a serosal patch or creation of a duodenojejunostomy.