Abstract
A 37-year-old man was seen at the hospital because of right lower abdominal pain, weight loss and fever. Physical examination revealed undernourishment, temperature of 38°C and a mass with tenderness in the right paraumbilical region. Colonoscopic examination demonstrated a stenosis in the hepatic flexure of the colon. Barium enema demonstrated segmental stenosis in the hepatic flexure with duodenocolic fistula. The patient was operated on with the intention of relieving the complaints. During surgery, inflammatory tumor was seen in the right colon and longitudinal ulcer, 45cm in length, was seen in the terminal ileum. Right colectomy with partial ileal resection, simple local debridement and primary closure of the duodenum were performed. The histologic diagnosis was Crohn's disease. Duodenocolic fistula is a rare complication of Crohn's disease and only three cases have been reported in Japan. Duodenocolic fistula having refractory clinical symptoms such as abdominal pain, fever and diarrhea, and associating with stenosis in the anal side of the colon should be regarded as the indication for operation.
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