Introduction The most common complications of Crohn's disease are the development of fistulas[1], abscess formation, malabsorption of bile acids, and adhesions. Rarely, Crohn's disease involves the stomach and the duodenum. We present a case of gastric outlet obstruction due to recurrent Crohn's disease. Case Report A 55-year-old male with a history of Crohn's disease in remission since 1990 presented with two weeks of nausea, vomiting, and 20 lbs. of weight loss. He had a remote history of antrectomy and ileocecectomy with no available details. In 2011, he had pyloric and postbulbar stenosis that required endoscopic dilatation. A computed tomography of the chest, abdomen and pelvis with contrast showed no acute findings. An outpatient esophagogastroduodenoscopy showed gastric outlet obstruction due to anastomotic stenosis of a previous antrectomy site and he was admitted. Initially, we treated the patient conservatively with intravenous fluids and proton pump inhibitors. However, he continued to have severe symptoms and eventually underwent duodenectomy with gastroduodenostomy. There were massive adhesions secondary to prior surgeries. The pathology report of the pylorus and duodenum resection (Figures 1 and 2) showed suppurative and granulomatous inflammation with focal abscess formation, adhesions, and stenosis consistent with Crohn's disease. On the tenth day of hospitalization, the patient recovered and was discharged home. Discussion While no controlled studies have been reported for the management of gastroduodenal Crohn's disease, the initial treatment typically includes corticosteroids and aggressive suppression of gastric acid using a proton pump inhibitor. Endoscopic balloon dilation can be used in short strictures. More severe strictures may require bypass via a gastrojejunostomy or gastroduodenostomy[2].2085_A Figure 1. Surface ulceration, crypt architecture distortion, and acute inflammation in the lamina propria with focal cryptitis.2085_B Figure 2. Granulomatous formation.