Korean J Gastroenterol.  2013 Feb;61(2):97-102. 10.4166/kjg.2013.61.2.97.

Crohn's Duodeno-colonic Fistula Preoperatively Closed Using a Detachable Endoloop and Hemoclips: A Case Report

• Park MS
• Kim WJ
• Huh JH
• Park SJ
• Hong SP
• Kim TI
• Kim WH
• Cheon JH

• KMID: 1775774
• DOI: http://doi.org/10.4166/kjg.2013.61.2.97

Abstract

Duodeno-colonic fistula is an enterocolonic fistula that occurs as a complication of Crohn's disease. Symptoms of duodeno-colonic fistula are similar to those of Crohn's disease, such as weight loss and diarrhea. The treatment of choice is surgery, although medical treatment may also be considered. However, surgery is recommended when all available medical therapies have been ineffective. In this case, we report a secondary duodeno-colonic fistula due to Crohn's disease that was temporarily managed by an endoscopic procedure with a detached endoloop and hemoclips as a bridging therapy to final surgical repair.

Keyword

Crohn disease; Intestinal fistula; Endoscopy

MeSH Terms

Adult
Crohn Disease/complications/*diagnosis
Endoscopy, Digestive System/instrumentation/methods
Female
Humans
Intestinal Fistula/*diagnosis/etiology/surgery
Preoperative Care
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Gastrografin hypotonic duo-denograph at admission. Fistula tract in the second portion of the duodenum was noted (arrows). The size of fistula opening measured approximately 1.5 cm.

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  Fig. 2. Computed tomography scan of abdomen and pelvis at admission. Mucosal enhancement and irregular wall thickening was present in the hepatic flexure of colon due to Crohn's disease involvement. Fistula formation between the hepatic flexure of the colon and the duodenal second portion was founded (arrows).

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  Fig. 3. (A) Esophagogastroduodenoscopy was performed at the first admission. A fistula tract was identified in the duodenal second portion. (B) Endoscopic procedure was performed for closing of fistula. Hemoclipping around the fistula was performed eight times and the fistula was occluded with a medium sized detachable snare.

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  Fig. 4. Endoscopic findings performed at the second admission. Duodeno-colonic fistula was noted recurrently and all of the hemoclips and the detachable snare used in the previous treatment disappeared. The fistula was closed by hemoclipping six times.

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  Fig. 5. Endoscopic findings at the third admission. Ten instances of hemo-clipping and two-time closure with a detachable snare loop were performed to close a recurrent duodeno- colonic fistula. However, a remnant fistula (arrow) persisted after this procedure, so surgery was considered.

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  Fig. 6. Patient's medical progress during treatment. WBC, white blood cells; PLT, platelets; Aza, azathioprine

Reference

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