An audit of gastroduodenal Crohn disease: Clinicopathologic features and management

Background: This study was undertaken to assess the clinicopathologic featu res and management of gastroduodenal Crohn disease. Methods: The medical re cords of 54 patients with gastroduodenal Crohn disease treated between 1958 and 1997 were reviewed. Results: Gastroduodenal Crohn disease occurred in association with disease elsewhere in 52 patients (96%). The commonest path ology was stricture (n = 41), followed by ulceration (n = 4) and duodenocut aneous fistula (n = 2). Medical treatment was initially attempted in 31 pat ients, of whom 12 required no surgical treatment for gastroduodenal disease . Nineteen patients required surgery for gastroduodenal obstruction or fist ula despite medical treatment. Overall, 33 patients (61%) required surgery; the indication was obstruction in 30, duodenocutaneous fistula in 2, and b leeding in 1. There was one postoperative death because of persistent bleed ing and intraabdominal sepsis after oversewing of a bleeding ulcer. In obst ructive disease 16 patients were treated by bypass surgery, 10 by stricture plasty, and 4 by gastrectomy. After surgery for obstructive disease anastom otic leak developed in three patients, and persistent gastric outlet obstru ction was seen in six patients. In the long term 11 patients required reope ration for anastomotic obstruction (n = 9) or stomal ulceration (n = 2). Fo r duodenocutaneous fistula one patient underwent simple closure of fistula, and the other patient duodenojejunostomy. Both of these patients developed an intra-abdominal abscess without evidence of leak. There has been no fis tula recurrence. Conclusions: Gastroduodenal Crohn disease is a complex and difficult problem that is associated with serious complications and need f or reoperation.