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Colobronchial fistula: a rare complication of Crohn's colitis
W Domej1, P Kullnig, W Petritsch
1Department of Medicine, Karl Franzens University School of Medicine, Graz, Austria.
Abstract:
A 29-yr-old white woman presented with chronic pneumonia in the left lower lobe and with left pleural effusion. She was known to have inflammatory bowel disease, but she was asymptomatic under maintenance treatment with 5-ASA. She received numerous antibiotic regimens according to susceptibility testing of microorganisms cultured from sputum and bronchial lavage and on an empiric basis was also given antituberculosis treatment, but there was no clinical improvement or change in the chest radiographic findings. Sputum was repeatedly examined and yielded, among other organisms, Clostridium inocuum, Enterobacter, Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus aureus. On one microscopic examination of sputum, the presence of feculent material was suspected. A subsequent gastrografin enema revealed a cologastric and colobronchial fistula between the splenic flexture of the colon and the greater curve of the stomach and the bronchial system. Segmental resection of the colon and resection of the lower lobe of the left lung were performed. Histologic findings of the resected colon were consistent with Crohn's disease. After a long period of postoperative recovery, the patient returned to good general health and well-being. To our knowledge, a colobronchial fistula caused by Crohn's colitis has not been previously reported.
Insights
A rare colobronchial fistula, a connection between the colon and the bronchial system, was diagnosed in a patient with Crohn's disease. Surgical intervention led to the patient's recovery and improved health.
Area of Science:
- Gastroenterology
- Pulmonology
- Surgical Case Report
Background:
- A 29-year-old woman with a history of inflammatory bowel disease presented with chronic pneumonia and pleural effusion.
- Standard antibiotic and antituberculosis treatments were ineffective, with no improvement in radiographic findings.
Observation:
- Sputum cultures revealed multiple organisms, and microscopic examination suggested feculent material.
- A gastrografin enema identified a cologastric and colobronchial fistula connecting the colon to the stomach and bronchial system.
Findings:
- Histological examination of the resected colon confirmed Crohn's disease.
- Surgical resection of the affected colon segment and the left lower lobe of the lung was performed.
Implications:
- This case represents a previously unreported instance of a colobronchial fistula secondary to Crohn's colitis.
- Successful surgical intervention led to the patient's recovery and improved general health.