Abstract
We performed laparoscopic-assisted total colectomy and fistulectomy for Crohn's disease (Crohn's colitis) associated with a jejunocolic fistula. The patient was a 32-year-old man who had been on internal treatment for Crohn's disease for recent 9 years. Colonoscopy performed to observe the clinical course revealed active longitudinal ulcer and multiple strictures from the hepatic flexure of the ascending colon to the sigmoid colon. Barium enema study showed a fistula between the splenic flexure of the transverse colon and the jejunum on the anal aspect of the Treitz ligament. Internal treatment was considered difficult, and he was referred to our department for surgical treatment. We performed laparoscopic-assisted surgery with the use of five ports. After dissecting the intestine from the ileocecal region to the rectum, we performed the resection of the rectum, followed by small laparotomy, under which the jejunocolic fistula was removed and a test material was collected under direct vision. In surgery treatment of Crohn's disease associated with a fistula, we can select laparoscopic-assisted surgery as an option, though we might have great difficulties in carrying out fistulectomy due to firm adhesions to the surroundings of the fistula.
