DUODENAL INVOLVEMENT OF CROHNS-DISEASE - 3 DIFFERENT CLINICOPATHOLOGICAL PATTERNS

PURPOSE: This study was designed to assess clinical and pathologic fea tures of duodenal Crohn's disease (CD) and address its management acco rding to different patterns of disease. METHODS: Twelve cases of duode nal involvement in CD are reported out of 336 patients treated between 1978 and 1993. They represent 3.6 percent of all cases. Three patient s had a duodenal fistula, and nine had an intrinsic duodenal lesion. T he duodenal fistula was in all cases a manifestation of recurrent CD i nvolving an ileocolic anastomosis and the third portion of the duodenu m. RESULTS: Treatment consisted of resection of the fistula's source a nd primary closure of duodenal breach. Of nine patients with intrinsic CD, five had stenosis and the remaining four had peptic ulcer-like le sions. Duodenal stenosis was treated with strictureplasty in three cas es and duodenojejunostomy in two. No patient with ulcer-like lesions u nderwent surgery. CONCLUSIONS: Differences encountered in intrinsic du odenal lesions apparently reflect two different clinical patterns. Ste nosis is not usually associated with multifocal disease and is often t he first evidence of disease. Ulcer-like lesions are not specific; the y do not evolve into stenosis as do ulcers in other sites of the disea se, spontaneously disappear and relapse, and do not require surgery, e xcept for complications. They are always associated with other locatio ns of the disease.