Upper gastrointestinal tract involvement in Crohn's disease: A case report. (April 2021)

• Record Type: Journal Article
• Authors: Orrell, Michael; van 't Hullenaar, Cas; Gosling, Jonathan
• Is Part Of: International journal of surgery case reports. Volume 81(2021)
• Publication Date: 2021-04
• Subjects: Case report -- Crohn's disease -- Upper gastrointestinal obstruction -- IBD surgery; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105810
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Upper gastrointestinal tract manifestations of Crohn's disease are unusual. There is limited literature guiding management decisions in affected patients. This case report highlights surgical management in this aspect of Crohn's disease. Abstract: Background: Crohn's disease (CD) is an inflammatory bowel disease that typically affects the distal part of the gastrointestinal tract (GI) such as the terminal ileum and colon. However, it can affect the upper GI tract, potentially resulting in complications such as strictures, but discussion of the management of such effects is limited in the surgical literature. Case presentation: A 39 year old male was referred to our department with stricturing upper GI disease 20 years after CD diagnosis. He had a history of intermittent abdominal pain, nausea, frequent vomiting and weight loss. Imaging demonstrated a long stricture in the duodenum with proximal dilatation. There was no evidence of acute inflammatory Crohn's disease. A Roux-en-Y bypass was performed to successfully relieve the obstructive symptoms. Discussion: Proximal obstructive gastrointestinal manifestations of CD are a rare entity and require a full diagnostic workup and treatment in a specialist centre. A variety of systemic treatments, endoscopic procedures and surgical techniques are addressed in this paper. Conclusion: Evidence for the optimal treatment of obstructive upper gastrointestinal CD is limited, but careful consideration of the extent of the disease, thorough preoperative planning and weighing up the benefits and risks can lead to a positive outcome for these patients.