Unusual case of a large small-bowel enteroenteric fistula successfully closed using purse-string sutures

A 28-year-old man was diagnosed with colonic Crohn’s disease with previous symptoms of diarrhea, weight loss, and vomiting 8 years ago. He was continually prescribed sulfasalazine (3 g/day) from the first diagnosis. During the medication period, these symptoms were successfully relieved. However, he was readmitted to our hospital 1 week ago with complaints of refractory diarrhea and vomiting.

Physical examination was normal except for diffuse abdominal tenderness, whereas laboratory tests revealed hemoglobin 73 g/L, potassium 3.3 mmol/L, sodium 128.6 mmol/L, and albumin 13.7 g/L. After the patient’s nutritional status had been improved, esophagogastroduodenoscopy was performed and showed a large fistula in the second portion of the duodenum ([Fig. 1]), extending to the jejunoileal lumen through the fistula tract ([Fig. 2]). A small-bowel enteroenteric fistula was diagnosed.

Fig. 1 A large fistula in the second portion of the duodenum.

Fig. 2 The jejunoileal lumen.

We used purse-string sutures, with an endoloop and hemostatic clips, to successfully close the fistula orifice ([Fig. 3], [Video 1]). The patient’s symptoms resolved after the procedure, and he was switched to anti-tumor necrosis factor agents for further treatment.

Fig. 3 Closure of the fistula orifice using purse-string sutures.

Video 1 Closure of the large small-bowel enteroenteric fistula.

Duodenal fistulas in patients with Crohn’s disease are rare and surgical treatment is usually recommended [1]. To our knowledge, this is the first case report of a large small-bowel enteroenteric fistula successfully closed using purse-string sutures.

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^* These authors contributed equally

Publication History

Article published online:
06 May 2020

• Reference

• 1 Tonkic A, Borzan V. Treatment of fistulizing Crohn’s disease. Acta Med Croatica 2013; 67: 191-194