INTRODUCTION: Crohn's disease (CD) is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. Duodenal CD is a rare clinical entity, with the majority of the patients being symptomless - its diagnosis requires a high level of clinical suspicion. CASE PRESENTATION: We present the case of a 29-year-old male patient with a 2-month history of weight loss, epigastric pain and postprandial vomiting. He underwent upper endoscopy, which revealed a circumferential duodenal ulcer causing non-transposable luminal stenosis and was medicated with proton pump inhibitors. While awaiting gastroenterology consultation, he presented at the emergency department for sudden onset of abdominal pain with dorsal irradiation, nausea and vomiting. Laboratory tests showed anaemia and increased liver enzymes, amylase and lipase. Abdominal computed tomography showed ectasia of the common bile duct (CBD) and intrahepatic biliary tract and a small amount of gas in the main pancreatic duct associated with duodenal thickening. The case was interpreted as probable CD complicated by pancreatitis and obstruction of the CBD, and he was hospitalized under antibiotic therapy and hydrocortisone with improvement of the condition. After discharge, he underwent colonoscopy that revealed several ulcers in the ileum and magnetic resonance imaging that showed distension of the stomach with reduction of the calibre of the transition from the duodenal bulb to the second portion of the duodenum in a 10- to 15-mm extension, as well as associated dilatation of the intrahepatic bile ducts and CBD and diffuse and regular ectasia of the main pancreatic duct. Combination therapy with azathioprine and infliximab was initiated; the patient presented clinical response at 12 weeks and endoscopic/imaging remission at 9 months. DISCUSSION/ CONCLUSION: Hepatobiliary and pancreatic manifestations are common in CD patients involving multiple mechanisms. In this case report, we pre-sent a patient with duodenal CD complicated with pancreatitis and CBD obstruction due to distortion phenomena by duodenal stenosis, a condition that is rarely described.
INTRODUCTION: Crohn's disease (CD) is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. Duodenal CD is a rare clinical entity, with the majority of the patients being symptomless - its diagnosis requires a high level of clinical suspicion. CASE PRESENTATION: We present the case of a 29-year-old male patient with a 2-month history of weight loss, epigastric pain and postprandial vomiting. He underwent upper endoscopy, which revealed a circumferential duodenal ulcer causing non-transposable luminal stenosis and was medicated with proton pump inhibitors. While awaiting gastroenterology consultation, he presented at the emergency department for sudden onset of abdominal pain with dorsal irradiation, nausea and vomiting. Laboratory tests showed anaemia and increased liver enzymes, amylase and lipase. Abdominal computed tomography showed ectasia of the common bile duct (CBD) and intrahepatic biliary tract and a small amount of gas in the main pancreatic duct associated with duodenal thickening. The case was interpreted as probable CD complicated by pancreatitis and obstruction of the CBD, and he was hospitalized under antibiotic therapy and hydrocortisone with improvement of the condition. After discharge, he underwent colonoscopy that revealed several ulcers in the ileum and magnetic resonance imaging that showed distension of the stomach with reduction of the calibre of the transition from the duodenal bulb to the second portion of the duodenum in a 10- to 15-mm extension, as well as associated dilatation of the intrahepatic bile ducts and CBD and diffuse and regular ectasia of the main pancreatic duct. Combination therapy with azathioprine and infliximab was initiated; the patient presented clinical response at 12 weeks and endoscopic/imaging remission at 9 months. DISCUSSION/ CONCLUSION: Hepatobiliary and pancreatic manifestations are common in CD patients involving multiple mechanisms. In this case report, we pre-sent a patient with duodenal CD complicated with pancreatitis and CBD obstruction due to distortion phenomena by duodenal stenosis, a condition that is rarely described.
Authors: Picha Moolsintong; Edward V Loftus; Suresh T Chari; Laurence J Egan; William J Tremaine; William J Sandborn Journal: Inflamm Bowel Dis Date: 2005-12 Impact factor: 5.325
Authors: María Rojas-Feria; Manuel Castro; Emilio Suárez; Javier Ampuero; Manuel Romero-Gómez Journal: World J Gastroenterol Date: 2013-11-14 Impact factor: 5.742
Authors: Sachin B Ingle; Baban D Adgaonkar; Nawab P Jamadar; Saleha Siddiqui; Chitra R Hinge Journal: World J Clin Cases Date: 2015-06-16 Impact factor: 1.337
Authors: Fernando Gomollón; Axel Dignass; Vito Annese; Herbert Tilg; Gert Van Assche; James O Lindsay; Laurent Peyrin-Biroulet; Garret J Cullen; Marco Daperno; Torsten Kucharzik; Florian Rieder; Sven Almer; Alessandro Armuzzi; Marcus Harbord; Jost Langhorst; Miquel Sans; Yehuda Chowers; Gionata Fiorino; Pascal Juillerat; Gerassimos J Mantzaris; Fernando Rizzello; Stephan Vavricka; Paolo Gionchetti Journal: J Crohns Colitis Date: 2016-09-22 Impact factor: 9.071