Laparoscopic assisted right hemi-colectomy for Crohn's disease after medical treatment for enterocutaneous fistula - Report of a case

Abstract

We report a case that of right colectomy and ileum resection assisted by laparoscopy for Crohn's disease that combined a stricture of the terminal ileum and subcutaneous abscess caused by a fistula between the ileum and abdominal wall. A 30-year old male undergoing treatment with steroids and enternal nutrition from 1996 for Crohn's disease experienced a subcutaneous abscess of the lower right abdomen on October 23, 2001, witch improved a few incision and drainage. It was thought to be due to a lesion accompanied by stricture of terminal ileum. He showed symptoms of abscess at the same site on December 17, 2001. When he reported abdominal in enternal nutrition at the same time, we expanded the stricture using an endoscopic balloon. When this proved ineffective decided on surgery. We waited until abscess inflammation went down and decreased the quantity of steroids, having him fast week of before surgery on February 19, 2002. Although the ileocecal portion and abdominal wall adhered strongly, detach went proved easy. He discharged without complication. Laparoscopic surgery for Crohn's disease accompanied by a fistula of the abdominal wall is thus possible with adequate preoperative management.