scholarly journals RARE COMPLICATION OF CROHN’S DISEASE WITH LOCALIZATION IN THE INFLAMMATORY INTESTINE IN THE F0ORM OF THE SPREAD OF INFLAMMATORY OF THE PROCESS ON THE ANTERIOR ABDOMINAL WALL WITH FORMATION ABSCESS AND ITS DISCLOSURE IN THE NAVEL

2021 ◽  
pp. 66-70
Author(s):  
O. A. Povch ◽  
S. O. Rebenkov ◽  
A. V. Kovalchuk ◽  
A. B. Bilyakov-Belskiy ◽  
V. M. Sidorenko ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Rare Complication ◽  
Abdominal Cavity ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Right Hemicolectomy ◽  
Complicated Course

The purpose of the study. Show a rare variant of the clinical course of complications of Crohn’s disease (СD). To analyze the anamnestic data, symptoms, clinical manifestations, preoperative diagnosis, features of surgery, postoperative period and the results of histological examination in a patient with CD who had complications in the form of transition of inflammation from the ileal wall to the anterior abdominal wall with abscess formation, opening it in the navel and the formation of a fistula. Material and methods. An analysis of the case of a complicated course of CD, manifested by the transition of inflammation from the ileum to the anterior abdominal wall, the formation of an abscess, its breakthrough into the navel and the formation of a fistula in the umbilical region. This complication was detected only after urgent computed tomography of the abdominal cavity and small pelvis (CTACSP). Results. The patient, despite the history of complaints, performed appendectomy, in which the removed appendix did not fully correspond to the clinical manifestations and data of CTACSP, in which CD was suspected, did not complete the examination, was not consulted by gastroenterologists and proctologists. He was urgently hospitalized with a clinic similar to acute purulent omphalitis. Only careful collection of the anamnesis and performance of urgent CTACSP allowed to suspect existence at the patient of the complicated course of CD. This allowed us to predict the course of surgery, perform a right hemicolectomy with excision of the altered tissues of the anterior abdominal wall and suturing the wound in the form of a laparostomy. The patient’s condition improved, he was discharged from the hospital. Conclusions. Patients with suspected CD should be monitored and treated by gastroenterologists and proctologists. Careful collection of anamnesis in patients of this group and the implementation of emergency CTACSP allowed to establish a correct diagnosis in the preoperative period.

scholarly journals Atypical Manifestation of Crohn’s Disease in a Teenage Girl

2021 ◽  
Vol 10 (1) ◽  
pp. 187-195
Author(s):  
E. V. Donskaya ◽  
V. P. Gavrilyuk ◽  
S. V. Kostin ◽  
D. A. Severinov ◽  
L. Y. Zakutayeva
Keyword(s):  
Crohn’S Disease ◽  
Body Temperature ◽  
Crohn's Disease ◽  
Abdominal Wall ◽  
Transverse Colon ◽  
Anterior Abdominal Wall ◽  
Abdominal Cavity ◽  
The Body ◽  
Greater Omentum ◽  
Teenage Girl

Crohn’s disease (CD) is nonspecific granulomatous inflammatory disease of all layers of the intestinal wall, characterized by a variety of clinical forms, heterogeneity of age groups of children and extraintestinal manifestations.  The diagnosis of the disease is difficult due to the presence of many  symptoms specific to a number of other surgical diseases of the abdominal cavity organs. This diagnosis is often made intraoperatively. In this study we report a case of treatment of a teenage girl who was admitted with complaints of a mass in the right iliac region extruding above the skin surface, instability of body weight, an increase in body temperature to 37.2° C for one month. As a result of laboratory and instrumental examination, the etiology was not established. Laparoscopy revealed abdominal infiltrate, consisting of the cecum, the distal ileum and a part of the greater omentum, tightly fixed to the anterior abdominal wall, which led to the destruction ofthe peritoneum, muscle tissue and aponeurosis with further infiltration into the sub-cutaneous fat. Appendectomy and separation of the infiltrate were performed. After that, the girl was discharged due to the categorical refusal of the parents of the further treatment.Twelve days later the patient had abdominal pain again, the dynamics of the pain syndrome intensified, the body temperature was febrile. After examination and detection of signs of peritonitis, emergency laparotomy, subtotal resection of the greater omentum, separation of the abdominal infiltrate (repeated), sanitation and drainage of the abdominal cavity were performed. During the surgery, the access to the abdominal cavity was performed with technical difficulties due to the fact that a conglomerate of intestinal loops and omentum was fixed to the anterior abdominal wall from the interior. The conglomerate was separated from the anterior abdominal wall by blunt dissection. The size of the conglomerate was up to 12–15 cm, formed by the transverse colon, the ileum and the greater omentum. The walls of the transverse colon and ileum in the area of the conglomerate had the cartilaginous density. For the purpose of further examination and determination of tactics for further treatment, the child was transferred to the Gastroenterology Department with a diagnosis of “Terminal ileitis. Purulent omentitis. Serous peritonitis. Mild normochromic anemia of mixed origin. Crohn’s disease?” After the additional examination in a specialized hospital, the diagnosis of CD was confirmed.

scholarly journals Iliopsoas Abscess as the First Clinical Manifestation of Crohn’s Disease - A Rare Case Report and Literature Review

2019 ◽  
pp. 1-3
Author(s):  
Cristiano Alpendre ◽  
Abdul Waheed ◽  
Cristiano Alpendre ◽  
Kai Huang ◽  
Nikita Sijapati ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Rare Complication ◽  
Right Hemicolectomy ◽  
Rare Presentation ◽  
Ct Guided ◽  
Iliopsoas Abscess ◽  
Rare Case Report ◽  
Duodenocolic Fistula ◽  
The Right

Objective: Iliopsoas abscess is a rare complication of fistulizing Crohn’s disease, which is difficult to diagnose and manage. We report this case to alert clinicians to the diagnosis and management of this unusual association. Case presentation: A 31-year-old male who presented with right groin pain, and hip pain due to an iliopsoas abscess. He was found to have iliopsoas fistula and underlying Crohn’s disease. The right iliopsoas abscess was managed with CT guided percutaneous drainage and pigtail catheter placement and intravenous antibiotics. The patient was started on mesalamine and prednisone. A month later, the patient became symptomatic again and a duodenocolic fistula was found. A laparoscopic extended right hemicolectomy with both fistulas takes-down, end ileostomy and mucus fistula were performed. Pathology revealed chronic active Crohn’s ileocolitis. His ileostomy was reversed three months later. The patient recovered uneventfully and was doing well after six-month follow-up. Conclusions: Iliopsoas abscess can be a rare presentation of Crohn’s disease. Evaluation with CT imaging, and initial management with drainage and antibiotics are recommended. Surgical intervention should be considered early for impending arthritis.

scholarly journals Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease

2021 ◽  
Vol 6 (5) ◽  
pp. 196-211
Author(s):  
M. N. Reshetnikov ◽  
D. V. Plotkin ◽  
Yu. R. Zyuzya ◽  
A. A. Volkov ◽  
O. N. Zuban ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Immunosuppressive Therapy ◽  
Abdominal Cavity ◽  
Intestinal Tuberculosis ◽  
Clinical Manifestations ◽  
Granulomatous Inflammation ◽  
Diagnostic Features ◽  
Fecal Matter

The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications. 

Quadriplegia, a Rare Complication of Pediatric Crohn's Disease, Successfully Treated with Endovascular Thromboembolectomy

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 408A-408A
Author(s):  
Riana Riffle ◽  
Amro Abdulsattar ◽  
Sean Meagher ◽  
Girish Deshpande
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Rare Complication

scholarly journals Crohn’s disease complicated with a bladder-fistula – a case report

2021 ◽  
Vol 19 (1) ◽  
pp. 76-80
Author(s):  
Grzegorz Pasternak ◽  
◽  
Dorota Bartusik-Aebisher ◽  
David Aebisher ◽  
Rafał Filip ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Urinary Tract ◽  
Crohn's Disease ◽  
Bladder Wall ◽  
Clinical Manifestations ◽  
Lower Abdominal Pain ◽  
Abdominal Ultrasound ◽  
Intestinal Loop ◽  
Ultrasound Computed Tomography ◽  
Bladder Fistula

Introduction. Entero-bladder fistula (fistula entero-vesicalis) is a pathological connection between the lumen of the gastrointestinal tract and the bladder. Entero-bladder fistulas are not a common condition. The main reason for the formation of entero- bladder fistulas are intestinal diseases occurring within the intestinal loop adjacent to the bladder resulting in the formation of an abnormal channel, the connection between the above structures Aim. The aim is to present the causes of the fistulas can be divided into congenital and acquired (intestinal infection, cancer, Crohn’s disease, resulting from trauma and iatrogenic). Clinical manifestations of the biliary-bullous fistulae may be from the digestive or urinary tract. The most characteristic ailments are pneumaturia, fecuria, urge to urinate, frequent urination, lower abdominal pain, hematuria, urinary tract infection. Description of the case. The article discusses the case of a patient with Leśniowski-Crohn disease complicated with a bladder- fistula. The treatment of entero-bladder fistulas is primarily surgical, it consists in resection of the fistula together with resection of the affected intestine and bladder wall fragment. Conclusion. The test confirming the presence of an entero-bladder fistula is a test with oral administration of poppies, although it happens that the test result may be negative, especially in the case of a bladder-follicular fistula. Among the tests useful in the diagnosis of entero-bladder fistula include abdominal ultrasound, computed tomography, magnetic resonance imaging, endoscopic tests (colonoscopy or cystoscopy).

scholarly journals Familial adenomatous colorectal polyposis complicated by colonic obturation: a clinical case

2020 ◽  
Vol 27 (6) ◽  
pp. 175-185
Author(s):  
V. M. Durleshter ◽  
A. A. Kryachko ◽  
K. D. Chuguzov ◽  
M. K. Tarlanova
Keyword(s):  
Intestinal Obstruction ◽  
Clinical Case ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Right Hemicolectomy ◽  
Stage Ii ◽  
Clinical Group ◽  
Colorectal Polyposis ◽  
General Weakness ◽  
Group 2

Background. Colorectal obturation is a fairly rare complication in patients with colorectal polyposis. Case descriptions of colonic obturation with underlying familial adenomatous colorectal polyposis have not been reported to date in national and foreign literature.Clinical Case Description. Patient G., female, 31 yo, was emergently admitted to a surgical unit with a preliminary diagnosis: acute intestinal obstruction, complaints of abdominal pain, nausea, vomiting, stool and gas outlet blockage, marked general weakness. Clinical and biochemical blood tests without peculiarities. Signs of intestinal obstruction in abdominal ultrasonic and X-ray examination. Obstructive right hemicolectomy performed as emergent surgery. Diagnosis: transverse colonic C-r T3NoMo, stage II, clinical group 2. Patient had routine fibrocolonoscopy in six months; polyps were revealed in all operated colon portions. APC genetic test was positive, total colectomy was decided with single-barrel ileostomy excretion on anterior abdominal wall. Definitive diagnosis: transverse colonic C-r T3NoMo, stage II, developed with underlying familial adenomatous colorectal polyposis, clinical group 2.Conclusion. Diagnosis of familial adenomatous colorectal polyposis with acute intestinal obturation is challenging due to forced urgent surgical intervention and lack of time for a detailed deeper examination in avoidance of baleful consequences. The case reported demonstrates that clinical manifestations of familial adenomatous colorectal polyposis extend beyond the routine complaints of abdominal bloating, stool blockage and rectal bleeding towards a formidable complication of acute colonic obturation of polypoid genesis.

Desmoid tumor of the anterior abdominal wall in a female (Clinical case)

2018 ◽  
pp. 116-118
Author(s):  
M.V. Makarenko ◽  
◽  
D.O. Govseyev ◽  
S.V. Gridchin ◽  
N.H. Isaeva ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Desmoid Tumor ◽  
Clinical Case ◽  
Anterior Abdominal Wall ◽  
Correct Diagnosis ◽  
Final Diagnosis ◽  
Histological Findings ◽  
History Of ◽  
Slow Growing ◽  
Wall Tumor

Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy and postoperative surgeries. Our clinical case is interesting because of the rarity of the pathology and the difficulties in setting the correct diagnosis. The patient, with a history of laparoscopic myomectomy (2012), was preparing for a routine surgery for the endometrioma of the anterior abdominal wall, according to the results of the ultrasound and computed tomography. After surgical treatment, the final diagnosis was changed, based on the histological findings. Key words: desmoid tumor, abdominal wall tumor, fibroid.

Crohn’s disease of the gallbladder

2021 ◽  
Vol 14 (9) ◽  
pp. e243579
Author(s):  
Callam Scott ◽  
Amit Patel ◽  
Noori Maka ◽  
Jonathan C MacDonald
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Gallstone Formation ◽  
Right Hemicolectomy ◽  
Chronic Cholecystitis ◽  
Pathological Examination ◽  
Key Factors ◽  
Chronic Inflammatory Condition ◽  
History Of ◽  
Lymphoid Aggregates

Crohn’s disease (CD) is a chronic inflammatory condition, which typically involves the small and large bowel but can affect any part of the gastrointestinal tract. Common symptoms include abdominal pain, diarrhoea, fatigue, weight loss and malnutrition. Complications of CD include gallstone formation and cholecystitis. Impaired reabsorption of bile salts in the small bowel and CD-related surgeries are key factors in the development of CD-related gallstones, although other factors are also important. Direct CD-related inflammation of the gallbladder is very unusual and the typical histological features of CD are rarely encountered in cholecystectomy specimens of individuals with CD. We present a case of a man in his early 60s with CD, previous right hemicolectomy and a history of gallstones, who presented with chronic cholecystitis. Following cholecystectomy, pathological examination of the gallbladder unexpectedly demonstrated typical features of CD, including lymphoid aggregates and non-caseating mucosal granulomata.

scholarly journals P262 Evaluation of zinc as a biomarker of a complicated course in paediatric Crohn's disease

2017 ◽  
Vol 11 (suppl_1) ◽  
pp. S210-S210
Author(s):  
S. Ben Avraham ◽  
R. Sigall Boneh ◽  
N. Cohen-Dolev ◽  
C. Sarbagili-Shabat ◽  
A. Levine ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Complicated Course ◽  
Paediatric Crohn’S Disease

scholarly journals Levels of TB-IGRA may help to differentiate between intestinal tuberculosis and Crohn’s disease in patients with positive results

2020 ◽  
Vol 13 ◽  
pp. 175628482092200
Author(s):  
Yujie Zhao ◽  
Meilin Xu ◽  
Liang Chen ◽  
Zhanju Liu ◽  
Xiaomin Sun
Keyword(s):  
Weight Loss ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Clinical Manifestations ◽  
Final Analysis ◽  
Interferon Gamma Release Assay ◽  
Significant Difference ◽  
History Of ◽  
Diagnosis Criteria

Aim: The aim of this study was to investigate the significance of positive tuberculosis interferon gamma release assay (TB-IGRA) in the differential diagnosis of intestinal tuberculosis (ITB) and Crohn’s disease (CD) patients, and to find a suitable threshold to help distinguishing CD from tuberculosis (TB), so as to provide better recommendations for clinical treatment. Methods: A retrospective study was performed including 484 patients who underwent TB-IGRA testing for suspected CD or ITB treated in the Shanghai Tenth People’s Hospital of Tongji University between January 2015 and May 2018. According to the diagnostic criteria, 307 patients, including 272 CD and 35 ITB patients, were recruited for the final analysis. We comprehensively and systematically collected their clinical manifestations, and analyzed the influence of TB-IGRA values referring to diagnosis criteria, and the possible causes of false positives. The receiver operator characteristic (ROC) curve and the cut-off value were applied to distinguish between ITB and CD patients. Results: Of the 56 patients with suspected CD enrolled, 23 were finally diagnosed with CD and 33 with ITB. In patients with TB-IGRA ⩾ 100 pg/ml, 4 cases were CD and 29 cases were ITB, while 19 cases were CD and 4 cases were ITB in patients with TB-IGRA < 100 pg/ml ( p < 0.05). TB-IGRA ⩾ 100 pg/ml indicated a high possibility of TB infection, with a sensitivity of 88% and a specificity of 74%. Three out of the four CD patients with TB-IGRA ⩾ 100 pg/ml had a history of tuberculosis, while only 1 of the 19 CD patients with TB-IGRA < 100 pg/ml had a history of tuberculosis ( p < 0.05). The average duration of ITB was 7 months, and that of CD was 46.8 months, thus a significant difference ( p < 0.05) was observed. Perianal lesions such as anal fistula or abscess were found in all CD patients. Among ITB patients, 8 out of 15 patients with TB-IGRA ⩾ 400 pg/ml experienced weight loss, while only 1 out of 18 patients with TB-IGRA < 400 pg/ml underwent weight loss ( p < 0.05). Conclusion: Patients with CD have longer duration of disease, and perianal lesions are more common in CD. ITB patients with TB-IGRA ⩾ 400 pg/ml experience weight loss more readily, which indicates that TB-IGRA value may be correlated positively with the severity of ITB. In patients with CD and ITB, TB-IGRA = 100 pg/ml may be a cut-off value of TB-IGRA. For patients with TB-IGRA ⩾ 100 pg/ml, it is recommended to use diagnostic anti-TB treatment first. Comprehensive analysis and judgment are required for patients with TB-IGRA from 14 pg/ml to 99 pg/ml. TB-IGRA false positivity may occur in patients with a history of TB infection.

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