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Enterocutaneous fistulas (ECFs) occurring in the setting of Crohn's disease (CD) are difficult to cure with medical treatment alone and affects a patient's quality of life. A 39-year-old man was diagnosed with an ileocolitis-type CD in 2007. His inflammation was insufficiently controlled despite the administration of an anti-tumor necrosis factor-alpha antibody. Therefore, he underwent subtotal colectomy, terminal ileal resection, and ileostomy for multiple colon and anal stenoses in Dec 2015. The patient subsequently received ustekinumab; however, purulent discharge was observed from a postoperative scar around the umbilicus in July 2019. In July 2021, enteroscopy and magnetic resonance imaging (MRI) showed an ECF extending from the small intestine to the umbilicus. Upon referral to our hospital, laboratory data showed elevated C-reactive protein (CRP) and serum amyloid A (SAA). After receiving colchicine, his purulent discharge disappeared, and his CRP and SAA levels rapidly decreased. Enteroscopy and MRI performed 1 year and 5 months after the administration of colchicine revealed ECF closure. Genetic analysis revealed that the patient harbored an MEFV exon 1 (E84K) mutation. [ABSTRACT FROM AUTHOR]

A young and otherwise healthy man was admitted to a district hospital, for treatment of adhesional disease developed as a result of complicated appendectomy two decades before. He was treated by laparoscopy, during which seven small-bowel loops were released from the abdominal wall. Nine days later, laparotomy became necessary because of recurrent intestinal obstruction. This laparotomy revealed two small bowel leakages in the right lower abdomen with purulent peritonitis. Resection of the leaking small bowel loops was performed. When the patient was transferred to our department, he was in a serious condition with persistent fever and a few days later multiple entero-cutaneous fistulae appeared in the wound, causing a large abdominal wall defect of 31 × 16 cm. Following 8 weeks of fistula-shrinking, the size of the defect was reduced to 17 × 9 cm. After resection of intestinal loops including multiple fistulae, a large abdominal wall-defect persisted. Hernia repair was performed 8 months after resection by intraperitoneal implantation of a large 30 × 40 cm ePTFE prosthetic patch (Gore-Tex®), fixed by transfascial subcutaneous sutures. Follow-up at 20 months revealed restoration of abdominal wall integrity and good general health. [ABSTRACT FROM AUTHOR]

The occurrence of enteric fistulae after wall repair using a prosthetic mesh is a serious but, fortunately, rare complication. We report the case of a 66-year-old diabetic man who presented with gas gangrene of the abdominal wall due to an intra-abdominal abscess caused by intestinal erosion six years after an incisional hernia repair using a polyester mesh. The aim of this case report is to illustrate the seriousness of enteric fistula after parietal repair using a synthetic material. [ABSTRACT FROM AUTHOR]