1
|
Sankararaman S, Sabe R, Sferra TJ, Khalili AS. Enterourachal Fistula as an Initial Presentation in Crohn Disease. Pediatr Gastroenterol Hepatol Nutr 2019; 22:90-97. [PMID: 30671379 PMCID: PMC6333586 DOI: 10.5223/pghn.2019.22.1.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 01/06/2023] Open
Abstract
Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we describe a 17-year-old male who presented with a history of recurrent anterior abdominal wall abscesses and dysuria. He was diagnosed with Crohn disease and also found to have a fistulous communication between the terminal ileum and a patent urachus. An ileocecectomy with primary anastomosis and complete resection of the abscess cavity was performed. He is on azathioprine for maintenance therapy and currently in remission. Clinicians should have a high index of suspicion for this complication in Crohn disease patients presenting with symptoms suggestive of urachal anomalies such as suprapubic abdominal pain, dysuria, umbilical discharge, and periumbilical mass.
Collapse
Affiliation(s)
- Senthilkumar Sankararaman
- Division of Pediatric Gastroenterology, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Ramy Sabe
- Division of Pediatric Gastroenterology, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Thomas J Sferra
- Division of Pediatric Gastroenterology, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Ali Salar Khalili
- Division of Pediatric Gastroenterology, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| |
Collapse
|
2
|
Kuroki H, Sugita A, Koganei K, Tatsumi K, Futatsuki R, Obara N, Arai K, Fukushima T. Crohn's disease manifesting as ileo-urachal fistula: Two cases reports and review of literatures. Int J Surg Case Rep 2018; 53:70-74. [PMID: 30390487 PMCID: PMC6215960 DOI: 10.1016/j.ijscr.2018.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/25/2018] [Accepted: 10/14/2018] [Indexed: 01/06/2023] Open
Abstract
Urachal tumor or umbilical discharge in Crohn’s disease are examined for internal fistula from diseased ileum to urachus. En broc resection with intestinal lesion and urachus is performed with successful outcome. Partial cystectomy is sometimes performed with urinary bladder inflamed.
Introduction: A fistula involving a patent urachus in a patient with Crohn’s disease is rare. Here we report ileourachal fistula formation in two patients with Crohn’ disease. Case presentations: The first patient was a 29-year-old man with Crohn’s disease and ileitis, and the second patient was a 43-year-old man with Crohn’s disease and ileitis. One of the patients showed pus/fecal discharge via the umbilicus. Both patients were eventually diagnosed with an ileourachal fistula associated with Crohn’s disease. In the first patient, the urachal remnant was connected to the urinary bladder and a Crohn’s disease-related intestinal lesion had formed a fistula to the urachus. In the second patient, a periumbilical inflammatory lesion extended to the bladder through the urachal remnant and to a longitudinal ulcer of the ileal lesion. The first patients underwent partial ileal resection, and partial cystectomy, while the second patient underwent urachal curettage, partial ileal resection, and partial cystectomy. In both. Conclusion: In cases of Crohn’s disease with an enterocutaneous fistula or pus discharge via the umbilicus, an examination to detect an urachal remnant with a fistula from the diseased intestine should be performed.
Collapse
Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Akira Sugita
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Kazutaka Koganei
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Kenji Tatsumi
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Ryo Futatsuki
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Nao Obara
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Katsuhiko Arai
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Tsuneo Fukushima
- Matsushima Clinic, 220-0045 3-138 Isecho Nishi-ku, Yokohama City, Japan.
| |
Collapse
|
3
|
Tsukui H, Koinuma K, Morimoto M, Horie H, Lefor AK, Kagaya Y, Takahashi H, Yano T, Matsubara D, Yamamoto H, Sata N. Crohn's disease presenting as a ceco-urachal fistula. Clin J Gastroenterol 2016; 10:32-36. [PMID: 27766543 DOI: 10.1007/s12328-016-0691-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 10/02/2016] [Indexed: 01/06/2023]
Abstract
We report the case of a patient with Crohn's disease who initially presented with a ceco-urachal fistula. The patient was a 31-year-old female who underwent an appendectomy 6 years before presenting to our institution. She had a one-year history of diarrhea, and had recently developed polyuria and a sensation of residual urine. She was admitted with fever and lower abdominal pain. Endoscopy and computed tomography revealed a ceco-urachal fistula, which was consistent with Crohn's disease. An urachal resection was performed, which included partial cystectomy and ileocecal resection. A ceco-urachal fistula is a rare initial symptom of Crohn's disease. During the surgical management of such cases, it is necessary to resect the urachus, the affected portion of the bladder, the fistula, and the affected part of the digestive tract in order to avoid recurrence.
Collapse
Affiliation(s)
- Hidenori Tsukui
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Koji Koinuma
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Mitsuaki Morimoto
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hisanaga Horie
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuka Kagaya
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Haruo Takahashi
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tomonori Yano
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | | | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| |
Collapse
|
4
|
Myers JN, Schäffer MW, Korolkova OY, Williams AD, Gangula PR, M’Koma AE. Implications of the colonic deposition of free hemoglobin-α chain: a previously unknown tissue by-product in inflammatory bowel disease. Inflamm Bowel Dis 2014; 20:1530-47. [PMID: 25078150 PMCID: PMC4134710 DOI: 10.1097/mib.0000000000000144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND We analyzed inflamed mucosal/submucosal layers of ulcerative colitis (UC = 63) and Crohn's colitis (CC = 50), and unexpectedly, we unveiled a pool of free hemoglobin alpha (Hb-α) chain. Patients with colitides have increased reactive oxidative stress (ROS), DNA oxidation products, free iron in mucosa, in preneoplastic, and in colitis-cancers and increased risks of developing colorectal cancer. All inflammatory bowel disease-related colorectal cancer lesions are found in segments with colitis. Linking this information, we investigated whether free Hb-α is key transformational stepping that increases colitis-related colorectal cancer vulnerability. METHODS UC/CC samples were profiled using matrix-assisted laser desorption/ionization mass spectrometry; protein identification was made by liquid chromatography. Diverticulitis was used as control (Ctrl). The presence of Hb(n) (n = α, β, or hemin)/Hb was validated by Western blotting and immunohistochemistry. We tested for DNA damage (DNAD) by exposing normal colonic epithelial cell line, NCM460, to 10 μM and 100 μM of Hb(n)/Hb, individually for 2, 6, and 12 hours. Quantification of Hb-α staining was done by Nikon Elements Advance Research Analysis software. ROS was measured by the production of 8-OHdG. DNAD was assessed by Comet assay. Colonic tissue homogenate antioxidants Nrf2-, CAT-, SOD-, and GPx-expressions were analyzed densitometrically/normalized by β-actin. RESULTS Immunohistochemistry of CC/UC mucosal/submucosal compartments stained strongly positive for Hb-α and significantly higher versus Ctrl. NCM460 exposed to Hb(n)/Hb exhibited steadily increasing ROS and subsequent DNAD. DNAD was higher in 10 μM than 100 μM in Hb-β/hemin the first 2 hours then plateaued followed by DNAD repair. This may be likely due to apoptosis in the later concentration. Nrf2 enzyme activities among UC, CC, and ulcerative colitis-associated colon cancer (UCAC) were observed impaired in all inflammatory bowel disease subjects. Decreased levels of Nrf2 among patients with UC versus patients with CC with active disease were insignificant as well as versus Ctrls but significantly lower in UCAC versus Ctrl. SOD was decreased in UC and UCAC and GPx in CC but statistically not significant. Comparing CC versus UC, SOD was significantly lower in CC (P < 0.05). CAT was observed increased among patients with CC/UC/UCAC and GPx in UC and UCAC versus Ctrl, respectively, and significantly increased in CC versus Ctrl (P < 0.01). CONCLUSIONS In the colitides, mucosal/submucosal tissue microenvironments demonstrated pool of free Hb-α chain. In vitro exposure of NCM460 cells to Hb(n)/Hb induced ROS and DNAD. Toxic effect of free Hb-α, in colonic epithelial cells, is therefore through production of ROS formation modulated by impairment of antioxidant effects. Targeting reduction-oxidation-sensitive pathways and transcription factors may offer options for inflammatory bowel disease-management and colitis-related cancer prevention.
Collapse
Affiliation(s)
- Jeremy N. Myers
- Department of Biochemistry and Cancer Biology, Meharry Medical College School of Medicine, Nashville, Tennessee
| | - Michael W. Schäffer
- Department of Biochemistry and Cancer Biology, Meharry Medical College School of Medicine, Nashville, Tennessee
| | - Olga Y. Korolkova
- Department of Biochemistry and Cancer Biology, Meharry Medical College School of Medicine, Nashville, Tennessee
| | - Amanda D. Williams
- Department of Biochemistry and Cancer Biology, Meharry Medical College School of Medicine, Nashville, Tennessee
| | - Pandu R. Gangula
- Department of Physiology, Meharry Medical College School of Medicine, Nashville, Tennessee
| | - Amosy E. M’Koma
- Department of Biochemistry and Cancer Biology, Meharry Medical College School of Medicine, Nashville, Tennessee
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
5
|
Mador BD, Blair GK. Pediatric Crohn disease complicated by an entero-uracho-cutaneous fistula. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
Dickhoff C, Campo MM, Ophof PJA, Makkus AFC, Tan KG, Plaisier PW. Urachus fistula: a rare first presentation of diverticulitis. Case Rep Gastroenterol 2008; 2:287-90. [PMID: 21490857 PMCID: PMC3075185 DOI: 10.1159/000151580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Urachus fistulas are rare, especially in adulthood. In grown-ups urachus fistulas are usually a reflection of Crohn's disease. We present a patient in whom an urachus fistula was the first presentation of diverticulitis of the sigmoid colon. The need for proper preoperative diagnostic imaging is discussed.
Collapse
Affiliation(s)
- C Dickhoff
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
7
|
Weitten T, Coca C, Ben Abdelghani M, Rohr S, Boujan E, Blicklé JF, Andrès E. [A urachus cyst revealing a torpid Crohn's disease in a young adult with chronic fever]. Presse Med 2005; 34:581-2. [PMID: 15962496 DOI: 10.1016/s0755-4982(05)83983-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION This case report describes a rare situation in which a superinfected cyst of the urachus complicated initially unknown and inactive Crohn's disease. CASE A 21-year-old man presented a chronic fever finally attributed to a superinfected urachal cyst. Six months after ablation of the cyst, progressive Crohn's disease was diagnosed. DISCUSSION The association of Crohn's disease and a superinfected urachal cyst is extremely rare. The case reported here is original in two aspects: the slowly progressive Crohn's disease was diagnosed after its complication; the superinfection developed through local bacterial translocation (ileal loop adjacent to the urachal cyst).
Collapse
Affiliation(s)
- T Weitten
- Service de médecine interne, diabète et maladies métaboliques, Hôpitaux Universitaires de Strasbourg
| | | | | | | | | | | | | |
Collapse
|