Foreign Body Ingestion Masquerading as Crohn’s Disease

Abstract

Introduction: A 48-year-old woman presents to clinic with chronic lower abdominal pain for 2 years. The pain described as severe and cramping, aggravated by eating food, stress and activity. There was also some associated loose stool. She further revealed having frequent epigastric burning, which she attributed to GERD. She never had a colonoscopy. Her history included ingestion of a quarter when she was 6 years old. It was assumed this had passed. She eventually underwent laparoscopy for these chronic GI symptoms 42 years later. The surgeon noted the presence of creeping fat mesentery in terminal ileum and she was labeled with a diagnosis of “Crohn’s disease.” A quarter was removed from her terminal ileum at that time. She was referred to GI clinic in order to further consider a diagnosis of Crohn’s. Her colonoscopy revealed stenosis in the terminal ileum with no inflammation in this area. Upper GI endoscopy showed mild gastritis. Biopsies from the stenotic region revealed normal findings. There was no evidence of IBD. Subsequent dilatation of the stricture was performed endoscopically after which her symptoms greatly improved. We report a case of foreign body ingestion, which after many years presented with abdominal pain and loose stool, with laparoscopic findings of creeping fat mesentery in the terminal ileum. There are few other reported cases in which foreign body ingestion chronically resulted in findings that mimic Crohn’s disease. To our knowledge, this is the first case in which foreign body ingestion has led to creeping fat mesentery in the terminal ileum. Moreover, this is a chronic case of foreign body ingestion with presentation after several decades. Crohn’s disease is an idiopathic, chronic inflammatory process of the GI tract that can affect any part of the GI system - from the mouth to the anus; however, the terminal ileum is involved in 70% of cases. The phenomenon of creeping fat in Crohn’s disease characterized by hypertrophy of mesenteric fat surrounding inflamed intestinal segments, and was first described by Burrill Crohn himself. Non-caseating granulomas are also a hallmark of Crohn’s disease, yet the absence of granulomas does not disqualify a diagnosis of Crohn’s disease. Upper and lower GI endoscopies are indispensable in diagnosing Crohn’s disease and differentiating it from foreign body ingestion. Endoscopies provide a direct visualization of the alimentary tract and help us take biopsies for histopathological confirmation. Other tests such as plain film and US are usually performed, but are of limited significance in differentiating Crohn’s from foreign body ingestion. Prognosis is good after removal of foreign body.