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

Mi Sung Park; Won Jin Kim; Ji Hye Huh; Soo Jung Park; Sung Pil Hong; Tae Il Kim; Won Ho Kim; Jae Hee Cheon

doi:10.4166/kjg.2013.61.2.97

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Park, Kim, Huh, Park, Hong, Kim, Kim, and Cheon: Crohn's Duodeno-colonic Fistula Preoperatively Closed Using a Detachable Endoloop and Hemoclips: A Case Report

Case Report

Korean J Gastroenterol 2013;61(2):97-102.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.2.97

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

Mi Sung Park¹, Won Jin Kim¹, Ji Hye Huh¹, Soo Jung Park^1,², Sung Pil Hong^1,², Tae Il Kim^1,², Won Ho Kim^1,², Jae Hee Cheon^1,²

¹Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

²Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Jae Hee Cheon, Institute of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, Korea. Tel: +82-2-2228-1990, Fax: +82-2-393-6884, E-mail: geniushee@yuhs.ac

Received 5 April 201225 May 2012 Accepted 29 May 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Crohn disease, Intestinal fistula, Endoscopy

References

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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.

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).

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.

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.

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.

Fig. 6.

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

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