A Clinical Study of Gastroduodenal Crohn's Disease Which Requires Operation

Masayuki Shibasaki, Yasutsugu Bandai, Kouji Kusaka, Masayoshi Ijichi and Shigehiro Kitamura*

Department of Surgery and Department of Pathology*, Social Insurance Chuo General Hospital

Introduction: Gastroduodenal involvement is frequently seen in Crohn's disease, but advanced lesions which require surgery are rare. We report results for surgery in gastroduodenal Crohn's disease. Patients and Methods: We reviewed the medical records of patients with gastroduodenal Crohn's disease operated on between January 1996 and December 2006. Results: Among the 893 laparotomies for Crohn's disease, 17 (1.9%) involved gastroduodenal Crohn's disease. Symptoms were vomiting in 13, abdominal pain in 3, and a combination of the two in 1. Pyloric stenosis was detected in all 15 patients undergoing gastrointestinal barium studies, with stenosis reaching the second portion of the duodenum in 10. Surgery involved 11 selective vagotomies and antrectomies, 3 distal gastrectomies, and 1 each of gastrojejunostomy, duodenal strictureplasty, and omental perforation plug. Mean operating time was 4 hours and 17 minutes and mean blood loss was 331 ml. Postoperative complications developed in 5 patients, i.e. 2 anastomotic stenoses requiring fasting, 2 of ileus, and 1 of gastroduodenal bleeding requiring surgery for hemostasis. There were 12 non-caseous epithelioid granulomas and 10 fistulas out of 14 resected specimens. One developed erosions at the anastomotic site but no stenosis was seen in the mean 43 months of follow-up. Discussion: Selective vagotomy and antrectomy in gastroduodenal Crohn's disease is considered useful because could resect fistulas complicating commonly, preserved large remnant stomachs and had good short-term results.

Key words
Crohn's disease, stomach, duodenum, operation, prognosis

Reprint requests
Masayuki Shibasaki Department of Surgery, Social Insurance Chuo General Hospital
3-22-1 Hyakuninncho, Shinnjuku-ku, 169-0073 JAPAN

Accepted
July 23, 2008

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