Duodenojejunal bypass and strictureplasty for diffuse small bowel Crohn's disease with a step-by-step visual guide

Abstract

Duodenal strictures in Crohn's disease (CD) are rare, and surgical management is challenging. Although short segment duodenal strictures may be managed by strictureplasty, longer strictures historically were managed with gastroduodenal bypass, and rarely with Whipple's procedure. However, both those operations are associated with significant short- and long-term complications. For long strictures of the third portion of the duodenum, a duodenojejunal (DJ) bypass procedure, which has rarely been reported in the CD surgical literature, may be a more physiologic option in select cases. We present a case of a patient with diffuse jejunoileitis with 26 strictures, including a 7-cm stricture of the third portion of the duodenum, who was managed successfully with a DJ bypass, multiple strictureplasty procedures, and a limited small bowel resection with a focus on intra-operative technique. DJ bypass is an alternative for successfully managing such strictures.