Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2020; 26(17): 2119-2125
Published online May 7, 2020. doi: 10.3748/wjg.v26.i17.2119
Gastrocolic fistula in Crohn’s disease detected by oral agent contrast-enhanced ultrasound: A case report of a novel ultrasound modality
Shuang Wu, Hua Zhuang, Jie-Ying Zhao, Yu-Fang Wang
Shuang Wu, Hua Zhuang, Jie-Ying Zhao, Department of Diagnostic Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yu-Fang Wang, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wu S collected the clinical information and drafted the first version of manuscript; Zhuang H drafted the manuscript for important intellectual content; Zhao JY critically revised the manuscript for important intellectual content; Wang YF acquired and interpreted diagnosis and clinical treatments information.
Supported by the National Nature Science Foundation of China, No. 81101061.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hua Zhuang, MD, PhD, Associate Professor, Department of Diagnostic Ultrasound, West China Hospital, Sichuan University, 37 Guo Xue Road, Wuhou District, Chengdu 610041, Sichuan Province, China. annzhuang@yeah.net
Received: January 15, 2020
Peer-review started: January 15, 2020
First decision: February 29, 2020
Revised: March 31, 2020
Accepted: April 10, 2020
Article in press: April 10, 2020
Published online: May 7, 2020
Processing time: 113 Days and 2.4 Hours
Abstract
BACKGROUND

Fistulas are common complications of Crohn’s disease (CD). Gastrocolic fistulas (GFs) are rare, occult and potentially life-threatening complications. Few cases of GFs have been reported. Oral agent contrast-enhanced ultrasound (OA-CEUS) is a novel technique of ultrasound (US) for gut. Contrast agent made by Chinese yam is taken orally to dilate the lumen of the upper gastrointestinal tract. Thus, the impediment of gas inside gastrointestinal tract is removed and a good acoustic window is provided for gastroin-testinal tract scanning. This paper describes a case of GF secondary to CD detected by OA-CEUS when it was missed by endoscopy and computed tomography (CT). To our knowledge, this is the first report of GF secondary to CD detected by OA-CEUS up to date.

CASE SUMMARY

A 29-year-old woman with a 6-year history of CD was admitted to our hospital for abdominal pain and diarrhea for 5 months without obvious predisposing causes. Initial gastroscopy failed to show any evidence of lesions. Colonoscopy revealed multiple erosions, mucosal nodularity, linear ulcers and a cobblestone appearance. A CT scan of her abdomen showed a complex multilocular structure adherent to the greater curvature of the stomach in her left lower abdomen, with fluid, gas and significant surrounding inflammation. CT also demonstrated an abdominal abscess, which was later treated with US-guided drainage. Colonoscopy, gastroscopy and CT missed the presence of a GF. OA-CEUS was performed. A contrast agent made from Chinese yam was taken orally to dilate the lumen of the gastrointestinal tract. A good acoustic window was provided for gastrointestinal tract scanning and the impediment of gas inside the gastrointestinal tract was removed. With the aid of the “window”, a canal with hypoechoic wall was identified connecting the greater curvature of stomach to the splenic colon flexure in free sections. We also observed the hyperechoic gas flowing dynamically inside the canal. Thus, a GF was suspected. US is the first imaging modality taking GF into account. At the same time, OA-CEUS identified the site of the fistula and its two orifices. Gastroscopy was performed again, revealing a small ulcer approximately 5 mm in diameter, which was considered as an orifice. On the basis of OA-CEUS and other examinations, the patient was diagnosed with a GF secondary to CD. Then, laparoscopic exploration, partial stomach resection, transverse colostomy and abdominal abscess drainage were performed. The patient recovered uneventfully.

CONCLUSION

GFs are rare, occult and potentially life-threatening complications in CD. US is one of the first-line modalities to evaluate CD and its complications. OA-CEUS, a novel technique of US for gut, may be helpful in reducing the possibility of a missed diagnosis of GF.

Keywords: Gastrocolic fistula; Ultrasound; Oral agent; Crohn’s disease; Complication; Case report

Core tip: Gastrocolic fistulas (GFs) are rare, occult and potentially life-threatening complications in Crohn’s disease (CD), which can indicate the active status of CD and predict a future surgery within a short period. Ultrasound is one of the first-line modalities to evaluate CD. Oral agent contrast-enhanced ultrasound (OA-CEUS) may be helpful in reducing the possibility of a missed diagnosis of GF. Only a few cases of GF have been reported in the current literature. Surgery is the definitive treatment for GF. It is important to identify and manage GF in a timely manner. This paper describes a GF secondary to CD detected by OA-CEUS when endoscopy and computed tomography missed the diagnosis.