Surgical management of duodenal Crohn's disease

Abstract

Background: The case of Crohn's disease involving the duodenum is rare, and its surgical management requires a thorough understanding.

Aim: To investigate the surgical management of duodenal Crohn's disease.

Methods: We systematically reviewed patients diagnosed with duodenal Crohn's disease who underwent surgery in the Department of Geriatrics Surgery of the Second Xiangya Hospital of Central South University from January 1, 2004, to August 31, 2022. The general information, surgical procedures, prognosis, and other information of these patients were collected and summarized.

Results: A total of 16 patients were diagnosed with duodenal Crohn's disease, where 6 cases had primary duodenal Crohn's disease, and 10 had secondary duodenal Crohn's disease. Among patients with primary disease, 5 underwent duodenal bypass and gastrojejunostomy, and 1 received pancreaticoduodenectomy. Among those with a secondary disease, 6 underwent closure of duodenal defect and colectomy, 3 received duodenal lesion exclusion and right hemicolectomy, and 1 underwent duodenal lesion exclusion and double-lumen ileostomy.

Conclusion: Crohn's disease involving the duodenum is a rare condition. Different surgical management should be applied for patients with Crohn's disease presenting with different clinical manifestations.

Keywords: Crohn’s disease; Duodenum; Inflammatory bowel disease; Surgical treatment.

Figure 1

The imaging examinations of patients with an internal fistula between the duodenum and colon. A: The abdominal computed tomography image showed the existence of an internal fistula between the duodenum and colon; B: The gastrointestinal radiography showed the existence of an internal fistula between the duodenum and colon; C: The ileocecus can be accessed through the internal duodenal fistula under gastroscopy; D: The internal fistula between the duodenum and colon under colonoscopy; E: The placement of jejunal nutrition tube under gastroscope.

Figure 2

Schematic diagram of pedicled terminal ileum flap closure of the duodenal defect. A: Pedicled terminal ileum (a), ileum (b), proximal ileum (c), transverse colon (d), Crohn's disease lesions (e); B: Duodenal defect repaired with a pedicled terminal ileal flap (a), terminal ileum (c), transverse colon (d); C: The duodenal defect was larger than 3 cm in diameter; D: Pedicled terminal ileum; E: Direct closure by mechanical stapling of duodenal defects was performed when the duodenal defect was ≤ 3 cm in diameter.