Crohn’s disease penetrating form. Difficulties of diagnostics and preoperative planning (clinical case)

Abstract

AIM: to demonstrate the difficulties of differential diagnosis of the penetrating variant of Crohn’s disease and malignant neoplasm of the intestine.PATIENTS AND METHODS: a clinical case of a patient of an older age group with the onset of a penetrating variant of Crohn’s disease is presented.RESULTS: according to the results of an urgent check-up on the day of admission, the patient had an abdominal mass in the right iliac region, involving the intestinal wall, anterior abdominal wall, complicated by acute intestinal obstruction. Preliminary diagnosis: colon tumor complicated by inflammation and acute intestinal obstruction. The patient’s condition and two life-threatening complications required an urgent surgical intervention — extended right-sided hemicolectomy. The primary histological examination also did not allow us to exclude the tumor nature, but a second revision of histology with immunohistochemical analysis made it possible to establish the diagnosis of Crohn’s disease.CONCLUSION: Crohn’s disease can debut at any age, including complicated forms. This requires the inclusion of this pathology in the differential diagnosis with malignant neoplasms of the intestine, especially when the changes are located in the right iliac region. This will help to optimize the surgical approach.