{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:46:39Z","timestamp":1783698399456,"version":"3.55.0"},"reference-count":54,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Crohn\u2019s disease is a chronic inflammatory condition with periods of exacerbation and remission that can involve any part of the gastrointestinal tract. The basic intestinal manifestation is frequently accompanied by extraintestinal involvement and may lead to complications such as perforations, fistulas and abscesses. Despite Crohn\u2019s disease being the most common reason of intestinal perforation, the other causes should be considered as well. Internalization of a foreign body, although rare, may still occur, especially in the pediatric population. Methods: The following case report presents the medical history of an 11-year-old patient who developed an enterocutaneous fistula two years after the diagnosis of Crohn\u2019s disease. Data analysis was carried out on the basis of patient medical records. Results: The fistula formed in the course of biological treatment during a period free of other symptoms indicating disease exacerbation. The imaging tests revealed the presence of a foreign body in the gastrointestinal tract, which could have been a potential cause of the observed inflammation that resulted in the development of the fistula. Conclusions: The presented case report as well as the literature indicate a correlation between the formation of intestinal fistulas and an active disease process. However, in the absence of symptoms of Crohn\u2019s disease exacerbation, other causes should be considered.<\/jats:p>","DOI":"10.3390\/jcm14072327","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T02:50:16Z","timestamp":1743389416000},"page":"2327","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Enterocutaneous Fistula in a Patient with Crohn\u2019s Disease After Internalization of a Foreign Body into the Gastrointestinal Tract"],"prefix":"10.3390","volume":"14","author":[{"given":"Wiktoria Hanna","family":"Buzun","sequence":"first","affiliation":[{"name":"Student Scientific Group of Gastroenterology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina Izabela","family":"Pe\u0142ka","sequence":"additional","affiliation":[{"name":"Student Scientific Group of Gastroenterology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4777-4024","authenticated-orcid":false,"given":"Aleksandra","family":"Z\u0142otowska","sequence":"additional","affiliation":[{"name":"Student Scientific Group of Gastroenterology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7984-2996","authenticated-orcid":false,"given":"Justyna","family":"\u0141uczak","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Urology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4583-5517","authenticated-orcid":false,"given":"Dariusz","family":"Patkowski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Urology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Pytrus","sequence":"additional","affiliation":[{"name":"2nd Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Kofla-D\u0142ubacz","sequence":"additional","affiliation":[{"name":"2nd Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kalla, R., Ventham, N.T., Satsangi, J., and Arnott, I.D. (2014). Crohn\u2019s disease. BMJ (Clin. Res. Ed.), 349.","DOI":"10.1136\/bmj.g6670"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.jpedsurg.2007.12.065","article-title":"Giovanni Battista Morgagni and his contribution to pediatric surgery","volume":"43","author":"Zani","year":"2008","journal-title":"J. Pediatr. Surg."},{"key":"ref_3","first-page":"33","article-title":"Management of complex perianal Crohn\u2019s disease","volume":"30","year":"2017","journal-title":"Ann. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1053\/j.gastro.2008.06.079","article-title":"Natural history of pediatric Crohn\u2019s disease: A population-based cohort study","volume":"135","author":"Balde","year":"2008","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5862","DOI":"10.3748\/wjg.v18.i41.5862","article-title":"Crohn\u2019s and colitis in children and adolescents","volume":"18","author":"Day","year":"2012","journal-title":"World J. Gastroenterol."},{"key":"ref_6","first-page":"257","article-title":"Guidelines for the management of patients with Crohn\u2019s disease. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology","volume":"16","author":"Eder","year":"2021","journal-title":"Prz. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1016\/S0140-6736(12)60026-9","article-title":"Crohn\u2019s disease","volume":"380","author":"Baumgart","year":"2012","journal-title":"Lancet"},{"key":"ref_8","first-page":"80","article-title":"Crohn\u2019s disease being caused by chronic inflammation of the digestive tract","volume":"7","author":"Wawryniuk","year":"2017","journal-title":"J. Educ. Health Sport"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Petagna, L., Antonelli, A., Ganini, C., Bellato, V., Campanelli, M., Divizia, A., Efrati, C., Franceschilli, M., Guida, A.M., and Ingallinella, S. (2020). Pathophysiology of Crohn\u2019s disease inflammation and recurrence. Biol. Direct, 15.","DOI":"10.1186\/s13062-020-00280-5"},{"key":"ref_10","unstructured":"Bartnik, W., and Szczepanek, M. (2024, October 21). Wrzodziej\u0105ce Zapalenie Jelita Grubego [w: Choroby Przewodu Pokarmowego]. Available online: https:\/\/ruj.uj.edu.pl\/xmlui\/handle\/item\/145408."},{"key":"ref_11","unstructured":"Farooqi, N., and Tuma, F. (2023). Intestinal Fistula. StatPearls, StatPearls Publishing."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tuma, F., Crespi, Z., Wolff, C.J., Daniel, D.T., and Nassar, A.K. (2020). Enterocutaneous Fistula: A Simplified Clinical Approach. Cureus, 12.","DOI":"10.7759\/cureus.7789"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3748\/wjg.v21.i1.12","article-title":"Modern management of anal fistula","volume":"21","author":"Limura","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Scharl, M., Rogler, G., and Biedermann, L. (2017). Fistulizing Crohn\u2019s Disease. Clin. Transl. Gastroenterol., 8.","DOI":"10.1038\/ctg.2017.33"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1055\/s-0036-1580732","article-title":"Enterocutaneous Fistula: Proven Strategies and Updates","volume":"29","author":"Melton","year":"2016","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_16","first-page":"507","article-title":"The etiology of enterocutaneous fistula predicts outcome","volume":"13","author":"Redden","year":"2013","journal-title":"Ochsner J."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Asghar, J.I., Crosby, J., and Beilman, G.J. (2012). Enterocutaneous fistula as early presentation of Crohn\u2019s disease in an adult woman. Case Rep., 2012.","DOI":"10.1136\/bcr.11.2011.5265"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1159\/000320416","article-title":"Fistula treatment: The unresolved challenge","volume":"28","author":"Vavricka","year":"2010","journal-title":"Dig. Dis."},{"key":"ref_19","first-page":"287","article-title":"Foreign body ingestion in children","volume":"72","author":"Uyemura","year":"2005","journal-title":"Am. Fam. Physician"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/MPG.0000000000003655","article-title":"Sharp-Pointed Foreign Body Ingestion in Pediatric Age","volume":"76","author":"Quitadamo","year":"2023","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1001\/archsurg.1986.01400080050009","article-title":"External duodenal fistula. Causes, complications, and treatment","volume":"121","author":"Rossi","year":"1986","journal-title":"Arch. Surg."},{"key":"ref_22","first-page":"143","article-title":"Enterocutaneous fistula treatment: Case report and review of the literature","volume":"39","author":"Assenza","year":"2018","journal-title":"J. Surg.-J. Ital. Surg. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/MPG.0000000000000239","article-title":"ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents","volume":"58","author":"Levine","year":"2014","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.bpg.2017.05.005","article-title":"Morphological classifications of gastrointestinal lesions","volume":"31","author":"Hazewinkel","year":"2017","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e222","DOI":"10.15557\/JoU.2020.0038","article-title":"Perianal lesions as an unusual first manifestation of Crohn\u2019s disease in pediatric patients\u2014Case series","volume":"20","author":"Zbroja","year":"2020","journal-title":"J. Ultrason."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Munster, L.J., M\u00f6nnink GL, E., van Dieren, S., Mundt, M.W., D\u2019Haens GR, A.M., Bemelman, W.A., Buskens, C.J., and van der Bilt, J.D.W. (2024). Fistulizing Perianal Disease as a First Manifestation of Crohn\u2019s Disease: A Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164734"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.clinre.2020.03.027","article-title":"Inflammatory bowel disease symptoms at the time of anal fistula lead to the diagnosis of Crohn\u2019s disease","volume":"44","author":"Yzet","year":"2020","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.1001\/jama.2013.4466","article-title":"Management of active Crohn disease","volume":"309","author":"Cheifetz","year":"2013","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1136\/gutjnl-2022-328052","article-title":"Efficacy of biological therapies and small molecules in induction and maintenance of remission in luminal Crohn\u2019s disease: Systematic review and network meta-analysis","volume":"72","author":"Barberio","year":"2023","journal-title":"Gut"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/S2468-1253(21)00312-5","article-title":"Comparative efficacy and safety of biologic therapies for moderate-to-severe Crohn\u2019s disease: A systematic review and network meta-analysis","volume":"6","author":"Singh","year":"2021","journal-title":"Lancet. Gastroenterol. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Velikova, T., Sekulovski, M., and Peshevska-Sekulovska, M. (2024). Immunogenicity and Loss of Effectiveness of Biologic Therapy for Inflammatory Bowel Disease Patients Due to Anti-Drug Antibody Development. Antibodies, 13.","DOI":"10.3390\/antib13010016"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4321\/S1130-01082013000100002","article-title":"Enterocutaneous fistulas and Crohn\u2019s disease: Clinical characteristics and response to treatment","volume":"105","year":"2013","journal-title":"Rev. Esp. Enfermedades Dig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"961","DOI":"10.3748\/wjg.v28.i9.961","article-title":"Relationship between clinical remission of perianal fistulas in Crohn\u2019s disease and serum adalimumab concentrations: A multi-center cross-sectional study","volume":"28","author":"Sirmai","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.2169\/internalmedicine.54.5405","article-title":"Effect of Adalimumab on an enterocutaneous fistula in patients with Crohn\u2019s disease: A case series","volume":"54","author":"Fujiwara","year":"2015","journal-title":"Intern. Med."},{"key":"ref_35","first-page":"113","article-title":"Cologastric fistula with a foreign body in a patient with Crohn\u2019s disease","volume":"83","author":"McGillicuddy","year":"2010","journal-title":"Yale J. Biol. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1053\/j.gastro.2020.07.065","article-title":"Predicting outcomes in pediatric crohn\u2019s disease for management optimization: Systematic review and consensus statements from the pediatric inflammatory bowel disease\u2013ahead program","volume":"160","author":"Ricciuto","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1053\/j.gastro.2021.12.282","article-title":"Twenty-first Century Trends in the Global Epidemiology of Pediatric-Onset Inflammatory Bowel Disease: Systematic Review","volume":"162","author":"Kuenzig","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_38","first-page":"628","article-title":"Toothpick foreign body perforation and migration mimicking Crohn\u2019s disease in a child","volume":"23","author":"Boyer","year":"1996","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Zhou, Q., Lu, X., Qian, L., Yu, C., Xie, J., and Kong, D. (2024). Procalcitonin, C-reactive protein, and white blood cell count levels in end-stage cancer patients: A retrospective study on inflammatory markers and their prognostic value. Medicine, 103.","DOI":"10.1097\/MD.0000000000040792"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Kapel, N., Ouni, H., Benahmed, N.A., and Barbot-Trystram, L. (2023). Fecal Calprotectin for the Diagnosis and Management of Inflammatory Bowel Diseases. Clin. Transl. Gastroenterol., 14.","DOI":"10.14309\/ctg.0000000000000617"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"8125","DOI":"10.3748\/wjg.v21.i26.8125","article-title":"Risk factors for complications associated with upper gastrointestinal foreign bodies","volume":"21","author":"Hong","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1177\/2050640618789853","article-title":"Enteroscopy in children","volume":"6","author":"Calabrese","year":"2018","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4253\/wjge.v12.i1.33","article-title":"Endoscopic removal of foreign bodies: A retrospective study in Japan","volume":"12","author":"Hosoe","year":"2020","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Dang, A.K., Choday, P., Buitrago, C., and Saffouri, G. (2025). Navigating the Hazards: A Case Study on the Complexities of Battery Ingestion in an Adult. Clin. Case Rep., 13.","DOI":"10.1002\/ccr3.70184"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/00000658-198701000-00013","article-title":"Spontaneous free perforation and perforated abscess in 30 patients with Crohn\u2019s disease","volume":"205","author":"Greenstein","year":"1987","journal-title":"Ann. Surg."},{"key":"ref_46","unstructured":"Ranasinghe, I.R., Tian, C., and Hsu, R. (2025, January 13). Crohn disease, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK436021\/."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s11845-007-0080-4","article-title":"Crohn\u2019s disease of the terminal ileum: A cheap diagnosis","volume":"177","author":"Gibson","year":"2008","journal-title":"Ir. J. Med. Sci."},{"key":"ref_48","first-page":"527","article-title":"Ingested toothpick fistula of the ileum mimicking Crohn\u2019s disease","volume":"73","author":"Ioannidis","year":"2010","journal-title":"Acta Gastro-Enterol. Belg."},{"key":"ref_49","first-page":"236","article-title":"An ileo-caecal foreign body mimicking a Crohn disease: Case report","volume":"31","author":"Montacer","year":"2018","journal-title":"Pan Afr. Med. J."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Visagan, R., Grossman, R., Dimitriadis, P.A., and Desai, A. (2013). \u2018Crohn\u2019z meanz Heinz\u2019: Foreign body inflammatory mass mimicking Crohn\u2019s disease. BMJ Case Rep., 2013.","DOI":"10.1136\/bcr-2013-009603"},{"key":"ref_51","first-page":"41","article-title":"Pen Foreign Body Ingestion Mimicking Crohn\u2019s Disease in a Pediatric Patient","volume":"105","author":"Donner","year":"2013","journal-title":"Rhode Isl. Med. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.1308\/rcsann.2021.0204","article-title":"Radiolucent foreign bodies presenting as inflammatory bowel disease: The case of an ingested plastic straw disguising as Crohn\u2019s","volume":"104","author":"Wadham","year":"2022","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Dines, J.T., and Harvey, A. (2021). Chronic intentional chicken bone ingestion mimicking inflammatory bowel disease. BMJ Case Rep., 14.","DOI":"10.1136\/bcr-2020-239022"},{"key":"ref_54","first-page":"749","article-title":"Ileal iterative spontaneous perforation from foreign body granuloma: Problems of histopathologic diagnosis","volume":"50","author":"Surlin","year":"2009","journal-title":"Rom. J. Morphol. Embryol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2327\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:04:43Z","timestamp":1760029483000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2327"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":54,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14072327"],"URL":"https:\/\/doi.org\/10.3390\/jcm14072327","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,28]]}}}