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Stefano Scaringi, Francesco Giudici, Gadiel Liscia, Cristina Cenci, Francesco Tonelli, Single-port laparoscopic access for Crohn's disease complicated by enterocutaneous fistula, Inflammatory Bowel Diseases, Volume 17, Issue 2, 1 February 2011, Pages E6–E7, https://doi.org/10.1002/ibd.21315
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To the Editor:
Single-port laparoscopic surgery represents the new frontier of minimally invasive surgery. Conventional laparoscopy allows for significant improvements in short-term postoperative outcomes, with low morbidity and better esthetic results compared with open surgery in the treatment of ileocolic Crohn's disease (CD).1 Reports of right and left single-port colectomy for early neoplasia and diverticular disease were published first by Bucher and Leroy,2,3 whereas only 1 report of complicated CD, successfully treated with single laparoscopic access, has been described, by Heeney.4 We report a case of ileocecal resection with single laparoscopic access for ileocolic CD complicated by enterocutaneous fistula.
A 27-year-old male patient was referred in October 2009 to our institution for chronic enterocutaneous fistula at the site of a previous surgical skin incision. Four months before, he had consulted the emergency department of a secondary general hospital for acute abdominal pain in the right iliac fossa associated with fever and moderate leukocytosis. He was brought to the operating room for suspected appendicitis. A McBurney's incision was performed, and CD was diagnosed intraoperatively. The appendix was not removed. The immediate postoperative course was uneventful. The patient was referred to a specialized gastroenterologist but 3 weeks later developed a wound abscess at the surgical site. A low output (<200 mL/24 h) enterocutaneous fistula appeared few days later. Endoscopy with biopsies of the terminal ileum confirmed the diagnosis of CD. Computed tomography showed a thickened terminal ileum with an enterocutaneous fistula penetrating through the previous surgical incision; no other proximal sites of disease were detected with a small bowel enema. Despite medical treatment and good general and nutritional status, the fistula persisted, and the patient was referred for surgery.
