A rare case of a duodenocolic fistula in a 3-year old child

Cover Page

Cite item

Abstract

Intraintestinal fistula is an unnatural communication between the intestinal cavity and other parts of the gut. Duodenocolic fistulas are common in adult patients with duodenal peptic ulcer or colon malignancies. In children, the formation of intraintestinal fistulas is possible as a rare complication of necrotizing enterocolitis of the newborn, after swallowing of several (two and more) magnetic foreign bodies localized in different parts of the digestive tract, as well as a complication of Crohn's disease at an older age. The article presents a clinical case of a duodenocolic fistula in a 3-year-old child. The patient Sh., 3 years and 2 months old, was admitted to the Pediatric Department of our clinic with a malabsorption syndrome and complaints of periodic vomiting after meals, weakness, tiredness, unstable light grayish stools, flatulence, periodic abdominal pains, and weight loss. There were clinical signs of stage II hypotrophy, protein and energy insufficiency. Laboratory tests showed low protein, albumin, and cholesterol levels, hypochromic anemia; fecal steatorrhea, creatorrhea, and amilorrhea. The differential diagnosis included intestinal malabsorption syndrome, presumably of a secondary origin, intestinal infection, congenital pancreatic disease, hereditary metabolic disorders, cystic fibrosis, celiac disease, lambliosis, and tumor. Multiple endoscopic and radiological examinations of the gastrointestinal tract were performed, but the intraintestinal fistula was identified only after repeated examinations. The patient's medical history from the first referral to the final diagnosis lasted about 9 months. The mechanism of the fistula formation in this patient is unclear. The clinical manifestation corresponded to the location of the fistula. In the long-term, the functioning of pathological intraintestinal communication could have a negative impact on the growth and development of the child; mucosal atrophy of the descending part of the intestine would have been possible, with progressive cachexy that could have become fatal.

About the authors

T. A. Bokova

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: bta2304@mail.ru

Tat'yana A. Bokova – MD, PhD, Professor, Chair of Pediatrics, Postgraduate Training Faculty.

61/2–5 Shchepkina ul., Moscow, 129110, tel.: +7 (495) 631 73 82

Russian Federation

A. E. Mashkov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Aleksandr E. Mashkov – MD, PhD, Professor, Head of Department of Pediatric Surgery.

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

E. V. Lukina

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Evgenia V. Lukina – MD, Junior Research Fellow, Pediatric Department.

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

V. V. Slesarev

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Vyacheslav V. Slesarev – MD, PhD, Senior Research Fellow, Department of Pediatric Surgery.

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

References

  1. Guyot D, Kuo P, Pawlotsky F, Papouin-Rauzy M, Delbreil JP. Intestinal fistula: an unusual complication of necrotizing enterocolitis in the preterm infant. Arch Pediatr. 2009;16(5): 435–8. doi: 10.1016/j.arcped.2009.02.005.
  2. Аверин ВИ, Голубицкий СБ, Заполянский АВ, Валек ЛВ, Никуленков АВ. Диагностика и лечебная тактика при магнитных инородных телах желудочно-кишечного тракта у детей. Новости хирургии. 2017;25(3): 317–23. doi: 10.18484/2305-0047.2017.3.317.
  3. Liu SQ, Lei P, Lv Y, Wang SP, Yan XP, Ma HJ, Ma J. Systematic review of gastrointestinal injury caused by magnetic foreign body ingestions in children and adolescence. Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14(10): 756–61. doi: 10.3760/cma.j.issn.1671-0274.2011.10.007.
  4. Pogorelić Z, Borić M, Markić J, Jukić M, Grandić L. A case of 2-year-old child with entero-enteric fistula following ingestion of 25 magnets. Acta Medica (Hradec Kralove). 2016;59(4): 140–2. doi: 10.14712/18059694.2017.42.
  5. Щербакова ОВ. Практические рекомендации по хирургическому лечению осложненной болезни Крона у детей. Экспериментальная и клиническая гастроэнтерология. 2015;(1): 78–83.
  6. Gong J, Wei Y, Gu L, Li Y, Guo Z, Sun J, Ding C, Zhu W, Li N, Li J. Outcome of surgery for coloduodenal fistula in Crohn's disease. J Gastrointest Surg. 2016;20(5): 976–84. doi: 10.1007/s11605015-3065-z.
  7. Park MS, Kim WJ, Huh JH, Park SJ, Hong SP, Kim TI, Kim WH, Cheon JH. Crohn's duodeno-colonic fistula preoperatively closed using a detachable endoloop and hemoclips: a case report. Korean J Gastroenterol. 2013;61(2): 97–102.
  8. Scharl M, Rogler G. Pathophysiology of fistula formation in Crohn's disease. World J Gastrointest Pathophysiol. 2014;5(3): 205–12. doi: 10.4291/wjgp.v5.i3.205.
  9. Черноусов АФ, ред. Хирургические болезни: учебник. М.: Гэотар-Медиа; 2010. 664 с.
  10. Захараш МП, Бекмурадов АР, Захараш ЮМ, Стеценко АП, Тарасюк ТВ, Мороз ВВ. Хирургическое лечение дуоденальных свищей. Хирургия. Журнал им. Н.И. Пирогова. 2012;(3): 49–53.

Supplementary files

There are no supplementary files to display.


Copyright (c) 2018 Bokova T.A., Mashkov A.E., Lukina E.V., Slesarev V.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies