Symptomatic differentiation of duodenal from gastric fistulas in Crohn's disease

Fistulization to the duodenum or stomach from a diseased segment of bowel in Crohn's disease is rare, with only 63 cases reported. We report an additional two cases of Crohn's disease with recurrent fistulization to the duodenum. Although one or both patients complained of pain, diarrhea, and/or weight loss at presentation, neither of them experienced vomiting or feculent eructation. A review of 46 of the 63 reported cases of gastric and duodenal fistulization indicated that patients with gastric fistulas commonly present with vomiting (39%), and with histories of feculent eructations or frank feculent vomiting (44%), but that patients with duodenal fistulas rarely present with vomiting (3.6%), and never have feculent vomiting or eructations. This difference is an important clue to the diagnosis and localization of upper gastrointestinal fistulas in Crohn's disease.