Ileal duodenal fistula with malnutrition caused by crohn disease, improved by operation

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.