Modified Percutaneous Endoscopic Gastrojejunostomy for Duodenal Fistula

Excerpt

Duodenal fistula rarely occurs in patients with Crohn’s disease (CD), most arising from recurrent disease at the ileocolic anastomosis [1]. The treatment for duodenal fistula includes medical or surgical management, and surgery is often required [1‐3]. We report the case of a 32-year-old male diagnosed with CD 8 years prior. He had undergone four operations owing to external and internal fistulas. However, the duodenal fistula recurred after operations, and was also unsuccessfully treated with medical therapy and a patch blocking (Fig. 1). Reoperation was not feasible in the short term, so the conservative treatment is challenging. We made a modified percutaneous endoscopic gastrojejunostomy (PEG-J) that was placed though the abdominal fistula to achieve decompression and enteral nutrition (Figs. 2, 3). The patient had no complications of duodenal fistula. One year later, the duodenal fistula was successfully treated by surgery (Fig. 4). We suggest that modified PEG-J is an option to treat upper gastrointestinal fistula that is inoperable.

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