A Case of Crohn's Disease with Retroperitoneal Abscess Due to Penetrating Lesion in the Duodenum

Tomohiro Saito, Toshio Saeki, Motoko Saito*, Kazuhiro Nomoto*, Kenji Tazawa*

Department of Surgery, Fujikoshi Hospital
*Second Department of Surgery, Toyama Medical and Pharmaceutical University

A 40-year-old man, who had undergone surgery for an anal fistula in June 1992, was hospitalized three times for paraumbilical pain. In June 1993, he was readmitted with fever and an infra-umbilical tumor. Barium meal examination revealed segmental stenoses and a cobblestone appearance in the ileum and ileal Crohn's disease was diagnosed. And abdominal computed tomography showed a massive heterogeneous lesion on the ventral side of the inferior vena cava, suggesting an intraabdominal abscess due to perforation of the ileal lesions. Surgical findings revealed a retroperitoneal abscess at the root of the mesentery connected to an ulcerative lesion in the third portion of the duodenum. Under a diagnosis of duodenal involvement of small intestinal Crohn's disease, partial duodenectomy and duodenojejunostomy were performed with ileocecal resection and ileocolostomy for the ileal stenotic lesions. To the best of our knowledge, this is the first report of duodenal Crohn's disease with a penterating lesion located in the third portion causing a retroperitoneal abscess. Because duodenal involvement of Crohn's disease is very rare in Japan, our knowledge of its clinical features is still deficient and thirty cases of duodenal involvement of Crohn's disease in the Japanese literature were discussed.

Key words
duodenal involvement of Crohn's disease, penetration of duodenum, retroperitoneal abscess

Reprint requests
Tomohiro Saito Second Department of Surgery, Faculty of Medicine, Toyama Medical and Pharmaceutical University
2630 Sugitani, Toyama, 930-01 JAPAN

Accepted
December 6, 1995

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