First Report of a Colopancreatic Fistula in Crohn s Disease

Case Report

Austin J Clin Case Rep. 2024; 11(1): 1312.

First Report of a Colopancreatic Fistula in Crohn’s Disease

Margies R¹*; Oberholzer K²; Seidmann L³; Bouzakri N¹; Mann C¹; Lang H¹; Horisberger K¹

¹Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany

²Department of Radiology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany

³Department of Pathology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany

*Corresponding author: Margies R Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes-Gutenberg-University, LangenbeckstraΒe 1, 55131 Mainz, Germany. Tel: 00491633024260 Email: rabea.margies@unimedizin-mainz.de

Received: November 24, 2023 Accepted: December 30, 2023 Published: January 05, 2024

Abstract

Penetrating complications in the sense of a fistula is a frequent problem in Crohn’s Disease; however, fistula formation into the tail of the pancreas has never been described. We report the case of a colopancreatic fistula in Crohn’s Disease, which has been successfully resected.

Keywords: Crohn’s disease; Colopancreatic fistula; IBD surgery

Abbreviations: CD: Crohn’s Disease

Introduction

Penetrating complication in Crohn's Disease in the sense of a fistula occurs in about 35% of patients with Crohn's disease. A recent population-based database analysis estimated the cumulative incidence of fistulizing CD at 20 years from diagnosis to be 50%, of which 31% were internal abdominal fistulae [1]. While some of them are rather common (entero-sigmoid or entero-entero fistulae), others are rarely encountered (e.g. entero- or colon-duodenal) [2].

Here, we report a case of a patient with a colopancreatic fistula in Crohn's colitis mimicking a cancer of the left flexure. To the best of our knowledge, there is no existing written evidence describing a histopathologically proven colo-pancreatic fistula.

Case Report

A 51-year-old woman presented to our emergency department with abdominal pain and the clinical picture of a subileus. She had a history of Crohn's Disease since 1999. In 2004, a right hemicolectomy was performed for perforation of the ascending colon. In 2015, she underwent a resection of the anastomotic region due to a stenosis of the ileo-ascending anastomosis. Reconstruction had to be performed as an end-to-end ileo-transverse anastomosis. In addition, a stenosis of the anal canal was intermittently dilated, most recently in 2021. Medical treatment was started in July 2020 with Azathioprin and in October 2021 with Infliximab.

On presentation in October 2022, the patient reported symptoms of intermittent nausea and diffuse spasmodic abdominal pain of several weeks' duration. Clinical examination revealed a distended abdomen with mild tenderness without muscular defense. The laboratory results showed an elevated CRP of 175mg/l and normal white blood cell count (4,4/nl). The last colonoscopy, performed in 2021, had already revealed a stenosis in the anastomosis area, which couldn´t be passed with the endoscope.

CT scan showed a stenosis in the region of the ileotransverse anastomosis with surrounding inflammatory reaction and suspicion of an abscess extending to the tail of the pancreas (Figure 1). A malignant process could not be ruled out in differential diagnostics.

Citation: Margies R, Oberholzer K, Seidmann L, Bouzakri N, Mann C, et al. First Report of a Colopancreatic Fistula in Crohn’s Disease. Austin J Clin Case Rep. 2024; 11(1): 1312.