Elective combined surgical management of concurrent gastrocolic and duodenocolic fistulae in longstanding Crohn's disease.

Abstract

Internal fistulization is a recognized complication of Crohn's disease, reflecting its transmural inflammatory nature and cumulative bowel damage over time. Internal fistulae occur in approximately 20-35% of patients with Crohn's disease, characteristically involving enteroenteric, ileosigmoid or enterovesical communications. In contrast, fistulous involvement of the stomach or duodenum is exceedingly rare, with only isolated cases and small case series reported in the literature. We report the case of a man in his 60s with longstanding Crohn's disease who was incidentally found to have concurrent gastrocolic and duodenocolic fistulae during investigation for acute calculous cholecystitis. Notably, the patient had been minimally symptomatic from a luminal disease perspective, with no clinical features suggestive of fistula-related complications, and his presenting symptoms were attributed to acute biliary pathology rather than chronic penetrating Crohn's disease. Cross-sectional imaging identified complex fistulous disease, confirmed on magnetic resonance imaging, which was addressed electively at the time of planned cholecystectomy, prior to the development of fistula-related morbidity. This case highlights the potential for clinically silent penetrating Crohn's disease and underscores the value of cross-sectional imaging and the potential role of proactive, elective surgical management. In this case, the postoperative course was uncomplicated and the patient remained clinically well at 9-month follow-up.