Cryptogenic multifocal ulcerous stenosing enteritis – a case report

Abstract

<h3>Background</h3> Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare condition characterised by chronic or relapsing episodes of small intestinal obstruction resulting from multiple small intestinal strictures and shallow ulcers. The aetiology of CMUSE has not yet been clarified, and pathogenesis is still poorly understood. Some authors suggest that CMUSE may be related to a particular form of vasculitis. <h3>Case report</h3> We present a case of a 33-year-old woman, who did not have a history of non-steroidal anti-inflammatory drug (NSAID) use, with multiple episodes of small intestinal obstruction. She underwent small bowel resection three times. The small bowel resection specimens macroscopically revealed multiple strictures and shallow ulcers. Microscopically, sections of both the ulcers and strictures showed broad based superficial ulceration of the mucosa and submucosa. The submucosa was thickened by fibrosis but the muscularis propria was nearly normal. Prominent lymphoid aggregates and granulomas were not identified. <h3>Conclusion</h3> The case exhibited features suggestive of CMUSE. CMUSE remains in part a diagnosis of exclusion, with Crohn disease, drug-induced small bowel ulceration, gluten sensitive enteropathy, peptic ulceration, lymphoma, infection, trauma, and ischaemia related to vasculopathy being the principal differential diagnostic considerations.