Successful Laparoscopic Treatment of Duodenal Stenosis in Crohnʼs Disease

Abstract

Introduction: Duodenal Crohn's disease (CD) is relatively rare and has an estimated incidence of 1% to 2% among patients with CD. Duodenal CD requiring surgery has traditionally been managed with an open bypass procedure. However, more recently, a laparoscopic treatment has become an acceptable surgical option. We report a case of severe duodenal stenosis in CD, successfully treated with laparoscopic gastroduodenal anastomosis (Jabouley's pyloroplasty). Case Presentation: A 30-year old man was diagnosed with CD at age 22 and had been treated medically, including the use of ASA and enteral diet. His disease was refractory to medical therapy, resulting in eventual laparoscopic subtotal colectomy at age 27. He subsequently complained postprandial vomiting and poor oral intake. He was admitted because of gastric outlet obstruction and a weight loss. Endoscopy and upper gastrointestinal (GI) tract X-ray showed a severe deformity and circular inflammatory stenosis of the proximal duodenum extending over 3 cm. A laparoscopic gastroduodenal anastomosis was indicated for duodenal stenosis. At laparoscopy, the duodenal wall was found to be thickened. A duodenal maneuver was fully made, while Jabouley-type pyloroplasty (gastroduodenal side by side anastomosis) was also performed by Endo GIA. A postoperative upper GI X-ray showed an improvement in the gastroduodenal passage. His postoperative course was uneventful and he has remained asymptomatic during follow-up period of 6 months. Discussion: Duodenal CD with severe stenosis has been treated by various modalities including endoscopic dilation, surgical bypass and strictureplasty. However, surgical interventions have been widely adopted because an endoscopic dilation has a high recurrence rate. More recently, a laparoscopic treatment has become an acceptable surgical option in the surgical management of CD. Laparoscopic intervention should be considered in surgical options, since CD is an unremitting condition in which operations are frequently multiple. Conclusion: Laparoscopic gastroduodenal anastomosis for duodenal CD is a useful and safe procedure.