Challenges in Crohn's disease: Crohn's disease involving the duodenum

Duodenal Crohn's disease (CD) is an uncommon condition, and the treatment options include medications, endoscopic dilation or surgical intervention. The most common indication for surgery is presence of progressive obstructive symptoms despite medical therapy or endoscopic dilatation. Surgical options for duodenal CD include bypass, resection or strictureplasty. However, as yet an optimal surgical strategy for duodenal CD has not been established. Fistula involving the duodenum in patients with CD is rare. Duodenal fistula almost always originates from the adjacent CD in the transverse colon or from an ileocolic anastomosis. In fact, an ideal surgical strategy for duodenal fistula remains to be defined. In this review, optimal therapeutic strategies, particularly appropriate to surgical approaches, for both duodenal CD and duodenal fistula are discussed.