Presentation Of Crohn Research Articles

Crohn’s Disease and Urinary Manifestations: A Crohn’s Intestinal Disease Mimicking a Bladder Mass

We report a rare mode of presentation of Crohn’s Disease (CD) in a 17-year-old boy, who was admitted at our hospital due to abdominal pain, dysuria, polyuria and fever. The ultrasound showed an increased wall thickness of the small bowel and cecum and a vegetating lesion adjoined into the bladder. The histology was not suggestive of CD and it excluded the bladder neoplasm. Based on the biochemical assessment and the imaging, we started the treatment specific for CD (nutritional therapy by Modulen, short courses of steroids, azathioprine and mesalazine during the follow up), These treatments improved the gastrointestinal symptoms and the nutritional status of our patient but also induced the disappearance of the mass adjoined into the bladder. In spite of the severe onset, in this patient, the clinical course of CD was mild and responder to conventional therapy.

Case Report: A Rare Presentation of Crohn’s Disease and Thyroid Dyscrasias in A 51-Year-Old Female

Reports have linked thyroid dyscrasias with inflammatory bowel disease and papillary carcinoma of the thyroid with Crohn’s disease. Here is presented a rare case of a patient with co-existing hyperthyroidism, papillary carcinoma of the thyroid and Crohn’s disease. After a 7-year history of Crohn’s disease that was resistant to medical management our patient developed hyperthyroidism and through a thyroidectomy her pathology report relieved papillary carcinoma of the thyroid. To the best of our knowledge these three pathologies have not simultaneously een presented in the current literature. This association is a novel finding and with further advances in research,our approach towards patients with Crohn’s disease might change.

Small Bowel Perforation Subsequent to Mushroom Bezoar as a Presentation of Crohn's Disease

Small Bowel Perforation Subsequent to Mushroom Bezoar as a Presentation of Crohn's Disease

Jejunal perforation: An unusual presentation of Crohn's disease

Introduction: Spontaneous perforation of the small intestine is a well­documented initial presentation or complication of Crohn’s disease. Review of literature shows that the most common site of free perforation is the ileum. Transmural inflammation of the intestinal walls makes them more susceptible to insult. Perforation of the jejunum as the initial presentation in Crohn’s disease is rare and not well described in literature. Case Report: We report a case of spontaneous jejunal perforation in a 34­year­old Caucasian male. Histopathological studies revealed Crohn’s disease. Conclusion: Our case brought to light an uncommon presentation of this disease. Isolated jejunal perforation as an initial presentation of Crohn’s disease is very rare. Prompt identification of this complication is essential in patients with Crohn’s disease and early referral for surgery is warranted.

Chronic pancreatitis as presentation of Crohn’s disease in a child

It is reported that a pancreatic disease may precede the diagnosis of inflammatory bowel disease (IBD) both in children and in adults. Idiopathic chronic pancreatitis, however, occasionally co-exists with the IBD, mainly at pediatric age. We report a case of a patient who progressively developed the features of a chronic pancreatitis, before the diagnosis of Crohn's Disease (CD). Ten months after the onset of the first episode of pancreatitis the patient developed bloody diarrhea, mucus stools and biochemical findings of inflammation. The colonoscopy revealed a diffuse colitis without involvement of the last loop and the gastroscopy showed inflammation of the iuxta-papillary area. The histological findings confirmed the diagnosis of CD that involved the colon and the duodenum. In conclusion, in children the idiopathic chronic pancreatitis may be an unusual presentation of CD. Thus, if other known cause of chronic pancreatitis are not found, a not invasive work up to exclude the IBD should be warranted. An early coincidental diagnosis of the IBD may delay the progression of the pancreatic disease.

Sternoclavicular Joint Arthritis as the Initial Presentation of Crohn’s Disease in an Adolescent

Sternoclavicular Joint Arthritis as the Initial Presentation of Crohn’s Disease in an Adolescent

Massive per rectal bleeding following blunt abdominal trauma: First presentation of Crohn's disease

IntroductionInflammatory bowel disease is a chronic and relatively common disorder with heterogeneous presentation. Peak incidence occurs in the second and third decades of life. We present a patient with Crohn's disease whose first presentation was profuse bleeding/rectum following blunt abdominal trauma. presentation of caseA 29 year old previously healthy man presented one hour after sustaining relatively mild abdominal trauma, due to fall onto the ball during a rugby match. He complained of abdominal pain and one episode of large fresh rectal bleeding. He was pale and distressed with hypotension, tachycardia and abdominal guarding & fresh blood on digital rectal examination. With a provisional diagnosis of intestinal injury he was taken to theatre. Right hemi-colectomy was done for a thickened and inflamed segment of distal ileum, a large adjacent mesenteric haematoma & mesenteric lymph nodes and blood in distal bowel. Histology confirmed the features of Crohn's disease. discussionCrohn's disease is unusual cause of massive lower gastrointestinal bleeding occurring in 0.9–6% of patients. Rectal bleeding associated with diarrhoea is relatively more common than massive bleeding. The presence of Crohn's disease in young patients presenting like this is unlikely to be suspected and diagnosis could only be made after laparotomy.

Exudative ascites as initial presentation of Crohn's disease: a case report

Exudative ascites as initial presentation of Crohn's disease: a case report

Crohn’s disease of the terminal ileum: a cheap diagnosis

A 29-year-old man was admitted with a 7-day history of progressive non-specific abdominal pain that progressed to small bowel obstruction following ingestion of a 20-pence coin 4-months previously. Colonoscopic retrieval was unsuccessful. A subsequent laparotomy revealed a chronically inflamed thickened terminal ileum with mesenteric fat encroachment necessitating a right hemicolectomy. Histopathological analysis confirmed Crohn's disease with impaction of the 20-pence coin in a distal terminal ileum stricture near the ileo-caecal valve. Gastrointestinal foreign body retention should alert the clinician to the presence of an undiagnosed bowel abnormality. Furthermore, failed endoscopic retrieval should be considered as a marker for potential underlying gastrointestinal pathology and a requirement for operative intervention. This case describes a rare presentation of Crohn's disease and highlights the need to consider underlying gastrointestinal pathology in patients presenting with a deteriorating clinical condition in the presence of an incidental foreign body.

Early oral presentation of Crohn's disease

Inflammatory changes of the oral mucosa in children can have a variety of infectious and non-infectious etiologies. We report on a 10-year-old boy with progressive cobblestone-like changes and erosions of oral mucosa over six months, which turned out to be early oral manifestations of Crohn disease.

Chronic IBD in Children in Central and Western Slovenia

Background: Data on the epidemiology of chronic inflammatory bowel disease in children in Slovenia is sparse. We evaluated the incidence, clinical and demographic features of pediatric inflammatory bowel disease (IBD) occurring in central and western Slovenia over the past 12 years. Methods: At the University Children's Hospital of Ljubljana we retrospectively collected data for all children with suspected IBD treated in the area of central and western Slovenia (7 pediatric and gastroenterology centers) in the 12-year period 1994-2005 using patient charts. IBD diagnosis was based on clinical presentation, endoscopy and histology results, disease activity was evaluated with PCDAI and UCAI. Results: The mean annual incidence of total pediatric IBD in central and western Slovenia was 4.03, the mean annual incidence of Crohn's disease (CD), ulcerative colitis (UC) and indeterminate colitis (IC) was 2.42, 1.14 and 0.47, respectively. In the last six-year period the incidence of total IBD rose almost 1.7-fold.TABLE 1: Mean and minimal age at presentation and mean duration of symptoms before disease diagnosisTABLE 2: Presentation of Crohn's disease (n = 82)TABLE 3: Extent of ulcerose colitis (n = 39)Disease severity was assessed using PCDAI and UCAI scoring systems. Of 82 children with newly diagnosed CD 39 (47%) had severe disease at its onset (PCDAI more than 30). Severe form of UC was present in 3 (8%) of total 39 patients with UC at its onset (UCAI more than 16). Conclusions: Incidence of total pediatric IBD in central and western Slovenia is high and seems to be still rising. Crohn's disease is the most prevalent form of IBD with incidence comparable to other central and western European countries. The incidence of UC and IC is rising more rapidly than the incidence of CD. CD is most commonly presented with inflammatory form of disease, almost half of the patients have severe form of CD at its onset. Pancolitis is the most frequent form of UC.

Vulvar ulceration with an unexpected underlying cause

In June, 2004, a 35-year-old white woman was referred to our hospital complaining of a painful area on her vulva. Her symptoms had been present for 1 week and she had lost 3 kg in weight in that time. Her medical history showed no relevant details with the exception of anal fi ssures. Physical examination showed two vulvar ulcers of about 15 mm in diameter on the inside of her left labium minus. Further gynaecological examination, however, showed no abnormalities. Laboratory test results showed a white blood count of 10·1×10 cells/L, with 74% neutrophils, and a C-reactive protein concentration of 85 mg/L. Diff erential diagnosis included infectious and malignant diseases. Cervical and urethral swabs were negative for chlamydia, gonorrhoea, and syphilis. Biopsy showed tissue fragments with a striking non-specifi c granulation tissue response, in the absence of epithelium or granulomas. Immunohisto chemistry for cytomegalovirus and herpes simplex virus was negative. A dermatologist suggested she had secondary impetiginisation after an infection with herpes simplex virus, and prescribed an antibacterial ointment (fusidic acid) to be applied on the ulcers. However, this treatment had no notable eff ect and the herpes-PCR and bacterial cultures were negative. 3 weeks after the patient’s initial out-patient visit, on further questioning she said that she had had anal bleeding three times in the previous month, as well as episodes of diarrhoea. Physical examination then showed three vulvar ulcers (fi gure), and on rectal examination we found an irregular rectal mucosa, probably caused by haemorrhoids. Because of rectal bleeding and diarrhoea, an underlying gastrointestinal disease as possible cause of her vulvar ulcerations was considered. At that time her C-reactive protein had increased to 136 mg/L and weight loss had progressed to a total of 8 kg. Colonoscopy showed macroscopic features of Crohn’s disease with a cobblestone appearance of the transverse colon and a mild terminal ileitis. Colon tissue biopsies showed a ulcerative non-specifi c infl ammation with granulomas. A diagnosis of Crohn’s disease of the colon and terminal ileum with vulvar manifestations was made. The patient was treated with prednisolone (for 10 weeks), vitamin D, and calcium, resulting in full clinical remission. When last seen, in October, 2005, she remained in clinical remission without signs of vulvar abnormalities. In this patient with vulvar ulceration, a gynaecological cause was initially considered because there were no other complaints and no abnormalities on physical examination. Vulvar ulceration as the primary presentation of Crohn’s disease is rare and diffi cult to diagnose owing to the many other causes of such ulceration. Case management can be diffi cult: treatment options include corticosteroids, sulfasalazine, azathioprine, and thalidomide. This case illustrates the importance of indepth questioning—earlier detailed inquiry could have prevented the referral to the wrong type of specialist. Doctors should bear in mind that a local problem can be a manifestation of a systemic disorder.

Life-threatening haemorrhage in Crohn's disease

Abstract An unusual presentation of Crohn's disease is reported. Massive rectal haemorrhage threatening the life of the patient resulted in emergency right hemicolectomy. No further bleeding has since occurred.

Unique presentation of Crohn's disease during treatment of Hodgkin's disease

Although Hodgkin's disease and Crohn's disease are associated with abnormalities in cell-mediated immunity, their co-existence in an individual patient is uncommon. To our knowledge, this is the first report of the clinical presentation of Crohn's disease during treatment for Hodgkin's disease. The basic immunologic mechanisms underlying these two pathologic states as well as chemotherapy-related effects are postulated as potential etiologic mechanisms for the codevelopment of these diseases. A brief review of the literature and basic immunologic defects associated with Crohn's disease and Hodgkin's disease are presented.

Aphthous Esophagael Ulceration: A Novel Presentation of Crohn’s Disease?

Crohn’s disease (CD) commonly presents as involvement of the small bowel or colon - the esophagus is rarely involved. The authors describe the case of a 45-year-old woman who presented with odynophagia and was found to have aphthous ulcers of the esophagus. On questioning, she admitted to three to four episodes of nonbloody diarrhea, each lasting less than one week, over the past two years. The patient denied other symptoms of gastrointestinal, collagen-vascular, respiratory or cardiovascular disease. Viral, fungal and bacterial cultures of blood, stool and tissue biopsies were all negative. A small bowel enema showed inflammation of the distal ileum. Colonoscopy revealed patchy areas of inflammation of the colon and distal ileum. Biopsies from the esophagus, duodenum, terminal ileum and colon showed chronic inflammation, lymphoid aggregates, goblet cell hyperplasia (in the colon) and crypt abscesses. Giant cells, granulomas and fissures were not evident in any of the biopsies. The patient failed to respond to a three-week course of omeprazole, but her symptoms resolved within three days of starting prednisone. The exact cause of the esophageal ulcerations is unknown but most likely is CD of the esophagus.

Granulomatous leg ulcers: An unusual presentation of Crohn's disease in a young man

Crohn's disease is a granulomatous disease of the bowel in which several extraintestinal manifestations have been described. Some cutaneous manifestations bear a close histologic resemblance to the bowel disease as noncaseating granulomas are present within the skin. When found in skin distant from the bowel, this has been termed metastatic Crohn's disease. We report the case of a young man with Crohn's disease who came to us for treatment of fungating leg ulcers.

Maladie de Crohn avec localisations ORL, trachéales, cutanées inaugurales, simulant une maladie de Wegener

We report the case of one patient with colonic Crohn's disease and severe tracheal involvement, cutaneous vasculitis and upper obstruction. This case demonstrates that the presentation of Crohn's disease may mimick that of Wegener's granulomatosis.

Small bowel phytobezoar mimicking presentation of Crohn's disease

A case of small bowel phytobezoar formed from unusual ingested vegetation is described. The patient presented with recurrent subacute obstruction and a right iliac fossa mass mimicking the presentation of Crohn's disease. None of the usual gastrointestinal disorders that predispose to bezoar formation were present. The phytobezoar passed spontaneously following small bowel enema and colonoscopy. It is possible that relaxation of the gut secondary to the antispasmodics administered at investigation or the physical disturbance during these procedures enabled migration through the ileocecal valve. Antispasmodics may be of use in the conservative management of bezoars obstructing otherwise normal bowel.

The gynaecological presentation of Crohn's disease

SummaryThe classic presentation of Crohn's disease is with lower abdominal pain and bowel upset associated with weight loss and other systemic manifestations. Although most patients go to a surgeon, the gynaecologist sometimes meets a patient with undiagnosed lower abdominal pain in the absence of bowel symptoms or with a persistent gynaecological problem such as vaginal discharge or dyspareunia.