Abstract
BackgroundCrohn’s disease is a chronic inflammatory condition that can affect the gut from mouth to anus. Gastroduodenal involvement is seen in less than 5% of all patients with Crohn’s disease. Among those cases, isolated gastric Crohn’s disease is even rarer. Although most patients with isolated gastric involvement have nonspecific complaints, very few of them do develop features of pyloric obstruction. There is a paucity of data on specific management of gastric Crohn’s disease owing to its rarity and its frequent coexistence with colonic or ileal disease. We report a case of a patient who had pyloric stenosis as a manifestation of isolated gastric Crohn’s disease responding to intralesional steroid injection and balloon dilation.Case presentationA previously healthy woman presented with recurrent postprandial vomiting, epigastric discomfort, and unintentional weight loss over 6 months. She had no diarrhea or extraintestinal manifestations. Clinically, she was pale and dehydrated. Examination of systems was unremarkable except for mild epigastric tenderness. Her initial laboratory findings were normocytic normochromic anemia, high inflammatory markers, and hypokalemia. Esophagogastroduodenoscopy revealed an inflamed pyloric mucosa with features of pyloric obstruction. Furthermore, magnetic resonance enterography confirmed the pyloric stenosis. Histopathological examination of a biopsy from the pylorus revealed noncaseating granuloma with superficial ulceration. Tuberculosis and sarcoidosis were excluded by appropriate investigations, and a diagnosis of gastric Crohn’s disease was made. Following the initial resuscitation, intralesional steroid injection and controlled radial expansion balloon dilation of the pylorus were carried out. The patient was commenced on azathioprine as a maintenance treatment, which led to a successful dilation and remarkable symptom improvement.ConclusionSymptoms of pyloric obstruction as a manifestation of isolated gastric Crohn’s disease are extremely unusual in clinical practice, awareness of which would facilitate early appropriate investigations and treatment.
Highlights
Crohn’s disease is a chronic inflammatory condition that can affect the gut from mouth to anus
Crohn’s disease is a chronic inflammatory condition characterized by segmental involvement of the gastrointestinal tract from mouth to anus
Gastroduodenal involvement is seen in less than 5% of all patients with Crohn’s disease [2]
Summary
Crohn’s disease is a chronic inflammatory condition that can affect the gut from mouth to anus. We report a case of a patient who had pyloric stenosis as a manifestation of isolated gastric Crohn’s disease responding to intralesional steroid injection and balloon dilation. We report a unique case of a patient with pyloric stenosis as a manifestation of isolated gastric Crohn’s disease responding to intralesional steroid injection and balloon dilation. Case presentation A 30-year-old Sri Lankan woman presented to the gastroenterology outpatient clinic of a tertiary care hospital with progressively worsening recurrent postprandial vomiting of 6 months’ duration She had epigastric discomfort, abdominal bloating, and unintentional weight loss of 7 kg. Diarrhea, prolonged fever, rash, or joint pain She had no medical or surgical comorbidities or history of acid/alkaline ingestion in the past. She had no family history of inflammatory bowel disease and no features of extraintestinal manifestations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
