P111 STRICTURING CROHN’S DISEASE OR A COMPLICATED MECKEL’S DIVERTICULUM WITH SMALL BOWEL STRICTURE?

Abstract

Distinguishing between inflamed Meckel’s diverticulum (MD) and ileal Crohn’s disease (CD) can be challenging. We present a case of suspected MD in a patient with CD. A 30 yr old male presented to the ED with episodic abdominal pain and rectal bleeding for 15 years, worse over three days. Physical exam was remarkable for abdominal tenderness. Laboratory workup showed a hemoglobin of 8.3 g/dl and normal inflammatory markers. Abdominal CT showed mesenteric lymphadenitis. EGD and ileocolonoscopy were visually normal, but random colonic biopsies showed chronic active colitis with focal cryptitis. MR enterography showed an abnormally dilated segment of bowel. Adalimumab was initiated for presumed CD, but pain persisted despite repeat ileocolonoscopy demonstrating histologic remission. He was readmitted with recurrent pain, and abdominal CT showed wall thickening within a small bowel loop in the right lower quadrant, with partial obstruction and dilation of the involved loop. He underwent laparotomy with bowel resection. Operative findings were notable for a tight stricture two feet from the ileocecal valve with outpouching segment of thickened bowel suggestive of MD. Pathology showed a two-inch diverticulum with sections of transmural inflammation and aphthous ulceration. No gastric or pancreatic mucosa were seen. The patient had resolution of symptoms and continues on adalimumab. There are multiple cases of MD in patients with CD and the inflammatory processes can be independent of each other.1 In our case, biopsies of gross appearance of MD showed changes suggestive of CD, indicating Crohn’s inflammation into the diverticulum. Distinguishing between both pathological processes is vital in such patients as this can impact lifelong therapy. 1. Spinelli A, Bazzi P, Spaggiari P, Danese S, Montorsi M. Surgical conduct in case of intraoperative detection of a meckel’s diverticulum in crohn’s disease. J Crohns Colitis.