S3586 Gastrocolic Fistula as Early Presentation of Crohn's Disease

Abstract

INTRODUCTION: Crohn’s disease is idiopathic chronic disease with chronic transmural inflammatory process which mainly affects the gastrointestinal tract, along with extra-intestinal manifestations. Though patients usually present with common symptoms including vague abdominal pain, diarrhea in second or third decade of life. Our case describes a woman in her sixth decade of life, without any previous history of typical Crhon’s disease symptoms, who presented with hyper defecation and having undigested food content in her stool. No reported abdominal pain or bloody stool. Workup demonstrated gastrocolic fistula and was eventually diagnosed with Crohn’s disease. CASE DESCRIPTION/METHODS: A 59-year-old female presented with hyper defecation and passing undigested food with her stool . She further reported increased appetite, yet associated with weight loss. CT scan showed inflammatory changes adjacent to the splenic flexure and lateral wall of the stomach with evidence of transverse colitis. Lab work shows mild leukocytosis and anemia. This unusual presentation of passing undigested food with her stool raised a suspicion of malabsorption syndrome and or pancreatitis. Malabsorption workup was negative. Gastrografin study was done and confirmed the presence of a gastrocolic fistula. She had colonoscopy which was essentially unremarkable. EGD was done which showed evidence of gastritis. Biopsy showed patchy transmural granulomas suggestive of Crhon’s disease. Laparotomy was done and patient underwent fistulectomy. No malignancy or abnormal growth was detected. Gastrocolic fistula is a rare, yet important find and should be recognized as a possible presentation of the disease at the time of diagnosis. DISCUSSION: Crhons disease can affect any part of the gastrointestinal tract. It usually has common presenting symptoms including abdominal pain, weight loss and bloody stool. Crhon’s disease can present with much rarer symptoms. Our case is interesting as disease presentation was mimicking pancreatic insufficiency/malabsorption syndrome. This case highlights the importance of considering that Crhon;s disease can manifest with it's advanced complication as presenting symptom.