Rare Enterohepatic Fistula in Crohn's Disease: Case Analysis and Literature Synthesis

Abstract

BACKGROUND Crohn disease is a chronic inflammatory bowel disease known for causing fistulous tracts, abscesses, and bowel perforation. Enterohepatic fistulas, a rare but significant complication, are scarcely reported. This article presents the case of a hepatic abscess due to an enterohepatic fistula in a patient with long-term Crohn disease and reviews the existing literature on this phenomenon. CASE REPORT A 59-year-old female patient with a known history of Crohn disease and previous ileocolic resection due to enteroenteric fistulas presented to our Emergency Department with right-sided abdominal pain persisting for 10 days. Diagnostic investigations, including imaging, revealed an enterohepatic fistula with a 3-4 cm hepatic abscess in segment V of the liver. Initial management involved conservative treatment with radiological drainage and antibiotics, leading to the patient's discharge. An elective laparotomy was scheduled 1 month later. The patient underwent resection of the ileocolic anastomosis with ileotransverse re-anastomosis and catheter removal. Postoperative management included treatment for paralytic ileus. She was discharged in good condition on postoperative day 11. CONCLUSIONS This report highlights the range of complications that can occur in patients with Crohn disease and presents the rare association between Crohn disease and enterohepatic fistula and abscess formation. Only 2 other case reports of enterohepatic fistula due to Crohn disease exist in the literature. Given the scarcity of evidence, no standardized guidelines are available, necessitating an individualized treatment approach. Initial conservative management can be effective; however, close monitoring is crucial to determine the need for subsequent surgical intervention.

Figure 1.

Coronal view of a computed tomography scan showing a liver abscess in segment V (arrow) communicating with the bowel in a 59-year-old female patient with Crohn disease presenting with right-sided abdominal pain.

Figure 2.

Transverse view of a computed tomography scan showing a liver abscess in segment V (red arrow) in a female patient with Crohn disease, despite being under steroid and immunomodulatory therapy. A fistula can be suspected but is not clearly visible (blue star).

Figure 3.

Computed tomography scan of a patient with Crohn disease on day 4 after drainage of a liver abscess, due to an enterohepatic fistula, showing complete regression of the abscess cavity, with the catheter in place (arrow).

Figure 4.

Resection specimen of an ileotransverse anastomosis from a 59-year-old patient with Crohn disease (CD), with the pointer highlighting the remnant of a fistula. The patient developed a liver abscess due to this fistula and had undergone ileocecal resection in 2017 to address CD-related entero-enteric fistulas.

Figure 5.

A low-power photomicrograph of part of the fistula between the bowel and liver (arrow) in a 59-year-old woman with a long-term history of Crohn disease The fistula tract has a wall of fibrous tissue with a dense chronic inflammatory cell infiltrate. Hematoxylin and eosin stain, magnification ×10.