Transverse Colonic Stricture Along with Colo-Duodenal Fistula—a Rare and Interesting Finding in Crohn’s Disease

Abstract

Colo-duodenal fistula is an extremely rare complication of Crohn’s disease (CD) and most patients require surgical treatment. The common presentation of such cases is fecaloid vomiting and the diagnosis is generally made by upper GI endoscopy. The presence of an associated colonic stricture further supports the fact that the disease started in the colon and requires surgical management to alleviate the symptoms. Small fistulas can be occluded with fibrin glue or clipping by endoscope, whereas the larger fistulas require surgical management. The patient presented to us with features of acute intestinal obstruction and was already on anti-tubercular therapy for 4 months due to a suspicion of abdominal TB. On examination, a lump was palpable in the right hypochondrium along with palpable bowel loops. CT scan showed mesenteric lymphadenopathy along with a stricture in the transverse colon which was confirmed by colonoscopy. A provisional diagnosis of malignant stricture with intestinal obstruction with high probability of carcinoma colon coexisting with tuberculosis was made and the patient underwent extended right hemicolectomy with ileocolic anastomosis with two-layered duodenal wall closure supplemented with jejunal serosal patch. The histopathology report was suggestive of CD. Thus, in any patient presenting with recurrent abdominal colics, episodes of obstruction or abdominal tuberculosis not responding to ATT, a differential diagnosis of IBD must always be kept in mind. The incidence of IBD is slowly rising in India over the past two decades.