Coloretroperitoneal Fistula of the Transverse Colon Caused by Crohn's Disease: A Case Report.
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Abstract
ABSTRACT.
Introduction: Crohn’s disease (CD) is an inflammatory bowel disease that can lead to severe complications such as fistulas. Colo-retroperitoneal fistulas are uncommon, and their origin in the transverse colon is exceptionally rare, representing a major diagnostic and therapeutic challenge. The aim of this report is to present a case of this atypical manifestation.
Case Report: We present the case of a 15-year-old male patient with fever, weight loss, abdominal pain, and hematochezia. An abdominal CT scan confirmed the presence of a fistula connecting the transverse colon with the retroperitoneum, along with significant colonic stenosis. The diagnosis of CD was established through biopsy. Due to the severity of the condition, a total colectomy with end ileostomy was performed, achieving clinical remission (Harvey–Bradshaw Index ≤4).
Discussion: This rare complication requires imaging studies such as computed tomography for diagnosis. Management is multidisciplinary, combining medical therapy with surgical intervention, which is reserved for complications or therapeutic failure. The goal of treatment is to control symptoms and achieve remission of this chronic disease.
Conclusion: This case illustrates the challenges posed by an atypical presentation of CD. We conclude that individualized surgical management is essential and effective in resolving severe complications, representing a necessary therapeutic option to achieve remission and patient well-being.
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References
I. Schneider AM, Nelson AM, Sch-Pennington N, Weidner T. Cutaneous manifestations of metastatic Crohn's disease. Pediatr Dermatol. 2018;35(5):566-74.
II. Ahad T, Lemberg DA, Leach ST, Yap J, Day AS. Vulvar swelling as the first presentation of Crohn's disease in children-a report of three cases. Pediatr Dermatol. 2018;35(1):e289-e291.
III. Reese LI, Tollefson MM. Crohn disease-associated genital edema. JAMA Dermatol. 2020;156(3):334.
IV. Wells LE, Cohen D. Delayed diagnosis of vulvar Crohn’s disease in a patient with no gastrointestinal symptoms. Case Rep Dermatol. 2018;10(3):263-7.
V. Leong RWL, Armuzzi A, Ahmad T, Wong P, Tse D, Jewell J, et al. Nod2/card15 gene polymorphisms and Crohn's disease in the Chinese population. Aliment Pharmacol Ther. 2003;17(12):1465-70.
VI. Instituto Mexicano del Seguro Social. Diagnóstico y Tratamiento de Enfermedad de Crohn en Población Adulta [Internet]. México: IMSS; 2014 [citado el 24 de junio de 2025]. Disponible en: http://www.cenetec.salud.gob.mx/interior/catalogoMaestroGPC.html
VII. Mukim M, Lahkar D, Singh S, Singh N, Gupta U, Kumar D, et al. Crohn’s disease: a review on epidemiology, diagnosis and therapeutic management. Indian Drugs. 2022;59(9):16-28.
VIII. Yamamoto-Furusho JK, Bosques-Padilla FJ, de-León-Rendón JL, et al. Epidemiología, carga de la enfermedad y tendencias de tratamiento de la enfermedad inflamatoria intestinal en México. Rev Gastroenterol Mex. 2020;85(2):170-9.
IX. Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut. 2014;63(9):1381-1392. doi:10.1136/gutjnl-2013-306709
X. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med. 2004;350(9):876-885. doi:10.1056/NEJMoa030815
XI. Bell SJ, Halligan S, Windsor AC, et al. Response of fistulating Crohn's disease to infliximab treatment assessed by magnetic resonance imaging. Aliment Pharmacol Ther. 2003;17(3):387-393. doi:10.1046/j.1365-2036.2003.01432.x
XII. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn's disease. Lancet. 2017;389(10080):1741–1755. doi:10.1016/S0140-6736(16)31711-1
XIII. Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18(1):56–66. doi:10.1038/s41575-020-00360-x
XIV. Baumgart DC, Sandborn WJ. Crohn's disease. Lancet. 2012;380(9853):1590–1605. doi:10.1016/S0140-6736(12)60026-9
XV. Sands BE. From symptom to diagnosis: clinical distinctions among various forms of intestinal inflammation. Gastroenterology. 2004;126(6):1518–1532. doi:10.1053/j.gastro.2004.03.019
XVI. Gaertner WB, Hagerman GF, Kwaan MR, et al. Fistulizing Crohn’s disease: perianal and enteroenteric fistulas. Clin Colon Rectal Surg. 2007;20(4):209–217. doi:10.1055/s-2007-991041
XVII. Lee SS, Kim AY, Yang SK, et al. Crohn disease of the colon: comparison of CT colonography and colonoscopy for detection of disease activity and severity. Radiology. 2006;240(3):767–776. doi:10.1148/radiol.2403051067
XVIII. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med. 2004;350(9):876–885. doi:10.1056/NEJMoa030815
XIX. Tjandra D, Garg M, Behrenbruch C, et al. Investigation and management of internal fistulae in Crohn's disease. Aliment Pharmacol Ther. 2021;53(10):1064-79.
XX. Benson AA, Aviran E, Yaari S, et al. Clinical and radiologic characteristics of intra-abdominal fistulizing Crohn's disease. Digestion. 2020;101(6):667-73.
XXI. Yoon YS, Yu CS, Yang SK, et al. Intra-abdominal fistulas in surgically treated Crohn's disease patients. World J Surg. 2010;34(8):1924-9.
XXII. Greenstein AJ, Dreiling DA, Aufses AH. Crohn's disease of the colon. V. Retroperitoneal lumbocrural abscess in Crohn's disease involving the colon. Am J Gastroenterol. 1975;64(4):306-18.
XXIII. Long-term outcomes of intestinal penetrating crohn’s disease following successful nonoperative management. european journal of gastroenterology & hepatology 2024;36(7):867-874. https://doi.org/10.1097/meg.0000000000002775
XXIV. Guía diagnóstica y terapéutica de la enfermedad inflamatoria intestinal. revista medica sinergia 2021;6(9):e713. https://doi.org/10.31434/rms.v6i9.713
XXV. Lightner AL, Vogel JD, Carmichael JC, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the surgical management of Crohn's disease. Dis Colon Rectum. 2020;63(8):1028-52.
XXVI. Lichtenstein GR, Loftus EV, Isaacs KL, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018;113(4):481-517.
XXVII. Heimann T, Greenstein AJ, Aufses AH. Surgical management of ileosigmoid fistula in Crohn's disease. Am J Gastroenterol. 1979;72(1):21-4
XXVIII. Tjandra D, Garg M, Behrenbruch C, et al. Investigation and management of internal fistulae in Crohn's disease. Aliment Pharmacol Ther. 2021;53(10):1064-79.
XXIX. Feuerstein JD, Ho EY, Shmidt E, et al. AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn's disease. Gastroenterology. 2021;160(7):2496-508.
XXX. Sánchez Bonilla E. Enfermedad de Crohn: un enfoque integral en su patogenia, diagnóstico y tratamiento. Rev Med Sinergia. 2023;8(8):e1092. doi: 10.31434/rms.v8i8.1092.
XXXI. Descripción epidemiológica y tratamiento de los pacientes con enfermedad de crohn. acta médica costarricense 2020;55(4). https://doi.org/10.51481/amc.v55i4.814