Crohn disease can develop stricture and perforation in any part of the alimentary tract. However, duodenal Crohn disease is rarely observed and often difficult to treat. A 52-year-old man with Crohn disease presented with general fatigue, appetite loss, abdominal pain and diarrhea. Although several drugs (steroids, 5-ASA, immuno-modulator, anti-TNF-a antibody) were administrated considering recurrence of Crohn disease, his manifestations did not disappear and his nutritional condition was also worsened. Several examinations revealed his malnutrition due to bowel short-circuiting by duodenal fistula to terminal ileum adding to refractory Crohn disease. To remove the shortcircuiting, operation was performed. After removing the short-circuiting and closing the fistula, ileal partial resection was performed. Duodenum was diverted, then Billroth-II gastrojejunostomy and jejunostomy was carried out. After the operation, he achieved maintenance therapy using anti-TNF-a antibody. Consequently, we have succeeded in improvement of nutritional status and have not identified any recurrence of Crohn disease for postoperative eight months.
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