S2788 A Rare Case of Duodenal Crohn’s Disease Presenting as Megaduodenum

Abstract

Introduction: Crohn’s disease of the duodenum is exceedingly rare and accounts for less than 2% of Crohn’s disease cases, disease confined to the duodenum is an even rarer entity.[1] Megaduodenum is typically seen in infants and its presence in adults is the subject of a few case reports. We present an unusual presentation of an adult patient with Crohn’s disease presenting as megaduodenum. Case Description/Methods: A 20-year-old male with a history of gastroparesis presented with mild epigastric pain, intractable nausea, vomiting, and 60 pounds of weight loss over the last six months. The patient had severe food intolerance to the point where he required total parenteral nutrition. CT scan showed distention of the stomach with tapering of the proximal duodenum, followed by subsequent marked diffuse distention of the remaining duodenum with subsequent narrowing at the duodenojejunal junction. (a). An esophagoduodenoscopy (EGD) was performed that showed distended duodenum, a proximal duodenal stricture, and another stricture at the duodenojejunal junction with inflamed mucosa and severe stenosis which could not be traversed. (b,c). Biopsies showed duodenitis consistent with Crohn’s disease. A PEG-J tube was placed for enteral feeding which the patient did not tolerate and ultimately required resection of the distended duodenum. Discussion: Megaduodenum is usually congenital and is a rare entity in adults. In this case, duodenal distention was likely acquired and unfortunately required resection due to the severity of symptoms. In our opinion, the patient likely had skipped lesions in the duodenum with significant dilatation of the inflamed area. There was no colorectal involvement confirmed by a colonoscopy. Post-operative biopsies also confirmed Crohn’s disease in the duodenum.Figure 1.: (a): Megaduodenum on CT scan Figure (b): Duodenal distention on EGD Figure (c): Duodenal stricture on EGD.