LAUSR

A 28-year-old man was diagnosed with colonic Crohn’s disease with previous symptoms of diarrhea, weight loss, and vomiting 8 years ago. He was continually prescribed sulfasalazine (3 g/day) from the first diagnosis. During the medication period, these symptoms were successfully relieved. However, he was readmitted to our hospital 1 week ago with complaints of refractory diarrhea and vomiting. Physical examination was normal except for diffuse abdominal tenderness, whereas laboratory tests revealed hemoglobin 73g/L, potassium 3.3mmol/L, sodium 128.6mmol/L, and albumin 13.7g/L. After the patient’s nutritional status had been improved, esophagogastroduodenoscopy was performed and showed a large fistula in the second portion of the duodenum (▶Fig. 1), extending to the jejunoileal lumen through the fistula tract (▶Fig. 2). A small-bowel enteroenteric fistula was diagnosed. We used purse-string sutures, with an endoloop and hemostatic clips, to successfully close the fistula orifice (▶Fig. 3, ▶Video 1). The patient’s symptoms resolved after the procedure, and he was switched to anti-tumor necrosis factor agents for further treatment. Duodenal fistulas in patients with Crohn’s disease are rare and surgical treatment is usually recommended [1]. To our knowledge, this is the first case report of a large small-bowel enteroenteric fistula successfully closed using pursestring sutures.