A Patient with Crohn’s Disease Presenting with a Picture Mimicking a Strangulated Incisional Hernia: A Case Report

Abstract

Objective: To report a case of Crohn’s disease that presented with a clinical picture mimicking a strangulated incisional hernia. Case Report: A 33-year-old Saudi male patient presented to the Emergency Department (ED) with vomiting, pain, and swelling at the right iliac fossa after lifting heavyweight objects two days earlier. The patient had a past history of appendectomy through a transverse incision nine years earlier. Clinically, the patient was vitally stable. He had tenderness at the right iliac fossa, and rebound tenderness. A tender swelling (6 x 8 cm) was observed underneath the previous scar. It was firm, not expansile on cough, and not reducible, with no redness or skin changes. The laboratory report showed normal results for complete blood count, apart from slight leukocytosis. Blood electrolyte levels, renal and liver function tests were normal. Plain CT abdomen showed a defect in the transversus abdominis muscle with the presence of swelling beneath the oblique muscles associated with air, which were connected to the bowel. The preliminary diagnosis was a “strangulated incisional hernia”. After laparotomy, the swelling showed pus within the external oblique aponeurosis, with a fistula tract connected to the ileum. After abdominal exploration, the inflammation was observed to be limited to the ileum and cecum with no other abnormality noted. Ileocecectomy was done with side-to-side anastomosis between the ileum and ascending colon. The resected part was sent for histopathology, which confirmed the characteristics of Crohn’s disease. Conclusions: The diagnosis of Crohn’s disease remains challenging. Its management is multi-disciplinary. Surgical management is dependent on disease location and severity. It seems that early surgery is gradually going to play a more important role in the multidisciplinary management of Crohn’s disease, rather than being a last-resort therapy. Key Words: Crohn’s disease, Diagnosis, Surgical management, Case Report.