Ileo-umbilical enterocutaneous fistula as the first manifestation of pediatric Crohn's disease: a case report

Enterocutaneous fistula (ECF) is an uncommon and challenging complication of Crohn's disease in the pediatric population. A 14-year-old female presented with a one-year history of chronic abdominal pain, weight loss, and a 6-month history of persistent feculent umbilical discharge following a prior "abscess" drainage. A CT scan revealed a fistula tract connecting the umbilicus to an inflammatory mass in the ileocecal region. She was optimized with nutritional support and antibiotics to correct her fever and elevated inflammatory markers. She then underwent a laparoscopic ileocecal resection. The bowel was connected to the umbilicus via a fistula tract, not dense adhesions. The bowel was exteriorized, and an ileo-colic anastomosis was performed with a linear stapler . Her recovery was uneventful. Pathology confirmed Crohn's disease. At one-year follow-up, she was in remission on medication, with full wound healing and weight gain. Crohn's disease should be suspected in patients who have a history of chronic abdominal pain, weight loss, and chronic purulent umbilical discharge, as the discharge can be an entero-cutaneous fistula.