A Rare Case of Isolated Duodenal Crohn’s Disease

Mohammed Ali; Hind Awad; Maurice Murphy; Ashraf Morcos

doi:doi:10.11648/j.ijg.20220601.14

| Peer-Reviewed

A Rare Case of Isolated Duodenal Crohn’s Disease

Mohammed Ali, Hind Awad, Maurice Murphy, Ashraf Morcos

Published in International Journal of Gastroenterology (Volume 6, Issue 1)

Received: 30 March 2022 Accepted: 21 April 2022 Published: 24 May 2022

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Crohn’s disease (CD) is an inflammatory bowel disease that is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. However, isolated duodenal involvement is rather extremely rare and diagnosis requires comprehensive clinical evaluation. Herein we present the case of a 55 –year lady who was referred to the gastroenterology team with a working diagnosis of possible malignant gastric outlet obstruction. The lady had no background medical or surgical history apart from being investigated for iron deficiency anemia years back by having gastroscopy and colonoscopy which were not significant. Her son was known to have Crohn’s disease. She was originally admitted to hospital with a history of upper abdominal pain, early satiety and weight loss. There were no bowel symptoms. Apart from iron deficiency anemia, her blood investigations were normal. The CT abdomen and pelvis showed duodenal wall thickening with a stricture but otherwise normal, including normal bowels. She had repeated gastroscopy, dilatation and sampling of the stricture site. The first two samples showed non-specific duodenitis. The diagnosis of isolated duodenal Crohn’s disease was made based on the samples from the third gastroduodenoscopy procedure which showed non-caseating granuloma. She had normal ileocolonoscopy and biopsies. Her fecal calprotectin was 230 micrograms per milligram (50-200). Based on the above findings she was put on a course of steroids and started on a standard dose of Infliximab infusion following negative surveillance to rule out latent Tuberculosis and to exclude other viruses as per protocol. The patient made marked clinical, endoscopic and histological response thereafter. This case emphasizes the challenge of diagnosing duodenal Crohn’s disease which, as above, might require high index of clinical suspicion and repeated sampling. We expect that this case report adds to the existing literature on this subject.

Published in	International Journal of Gastroenterology (Volume 6, Issue 1)
DOI	10.11648/j.ijg.20220601.14
Page(s)	18-21
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Crohn’s Disease, Duodenal Crohn’s, Isolated Duodenal Crohn’s Disease, Non-caseating Granuloma, Case Report

References

[1]	Kefalas CH. Gastroduodenal Crohn’s disease. Proc (Bayl Univ Med Cent) 2003; 16: 147-151. [PMC free article] [PubMed] [Google Scholar].
[2]	Ingle SB, Adgoankar, Jamadar NP, Siddiqui S, Hinge CR. Crohn’s disease with gastroduodenal onvolvement: Diagnostic approach. World j Clin Cases. 2015; 3: 479-483. [PMC free article] [PubMed] [Google Scholar].
[3]	Gottlieb C, Alpert S. Regional jrjunitis. Ann J Roentgenol. 1937; 38: 881-883. [Google Scholar].
[4]	Amy L Lightner, MD, Duodenal Crohn’s Disease, Inflammatory Bowel Diseases, Volume 24, Issue 3, March 2018, Pages 546–551, https://doi.org/10.1093/ibd/izx083 [Google Scholar].
[5]	Kim YL, Park YS, Park EK, et al. Refractory duodenal Crohn’s disease successfully treated with infliximab. Intest Res. 2014; 12: 66–69. [Google Scholar].
[6]	Sousa M, Proença L, Carlos Silva J, Ribeiro Gomes AC, After E, Carvalho J. Duodenal Crohn's Disease Complicated by Pancreatitis and Common Bile Duct Obstruction. GE Port J Gastroenterol. 2020 Jan; 27 (1): 33-36. doi: 10.1159/000499767. Epub 2019 May 23. PMID: 31970238; PMCID: PMC6959094. [PubMed] [Google Scholar].
[7]	J. J. Murray, D. J. Schoetz Jr., F. W. Nugent, J. A. Coller, and M. C. Veitenheimer, “Surgical management of Crohn's disease involving the duodenum,” The American Journal of Surgery, vol. 147, no. 1, pp. 58–65, 1984. [Google Scholar].
[8]	F. W. Nugent and M. A. Roy, “Duodenal Crohn's disease: an analysis of 89 cases,” The American Journal of Gastroenterology, vol. 84, no. 3, pp. 249–254, 1989. [Google Scholar].
[9]	Inayat F, Ullah W, Hussain Q, Shafique K. Crohn’s disease presenting as gastric outlet obstruction: a therapeutic challenge? BMJ Case Rep. 2017; 2017.
[10]	Annunziata ML, Caviglia R, Paparella LG, Cicala M. Upper gastrointestinal involvement of Crohn’s disease: a prospective study on the role of upper endoscopy in the diagnostic work-up. Dig Dis Sci. 2012; 57: 1618–1623. [PubMed] [Google Scholar].
[11]	Wolfson DM, Sachar DB, Cohen A, Goldberg J, Styczynski R, Greenstein AJ, Gelernt IM, Janowitz HD. Granulomas do not affect postoperative recurrence rates in Crohn's disease. Gastroenterology. 1982; 83: 405-409. [PubMed] [Google scholar].
[12]	Keller KM, Bender SW, Kirchmann H, Ball F, Schmitz-Moormann P, Wirth S, Baumann W. Diagnostic significance of epithelioid granulomas in Crohn's disease in children. Multicenter Pediatric Crohn's Disease Study Group. J Pediatr Gastroenterol Nutr. 1990; 10: 27-32. [PubMed][Google scholar].
[13]	Khanna S, Gupta P, Khanna R, Dalela D: Distal duodenal obstruction: a surgical enigma. Indian J Surg. 2017, 79: 245-53. 10.1007/s12262-017-1604-4.
[14]	Serracino-Inglott F, Smith GH, Anderson DN: Duodenal webs--no age limit. HPB (Oxford). 2003, 5: 186-7.10.1080/13651820310001306.
[15]	So H, Ye BD, Park YS, Kim J, Kim JS, Moon W, Lee KM, Kim YS, Keum B, Kim SE, Kim KO, Kim ES, Lee CK, Hong SP, Im JP, Koo JS, Choi CH, Shin JE, Lee BI, Huh KC, Kim YH, Kim HS, Park YS, Han DS Korean Association for the Study of Intestinal Diseases. Gastric lesions in patients with Crohn’s disease in Korea: A multicenter study. Intest Res. 2016; 14: 60–68. [PMC free article] [PubMed] [Google Scholar].

Cite This Article

Plain Text BibTeX RIS

APA Style

Mohammed Ali, Hind Awad, Maurice Murphy, Ashraf Morcos. (2022). A Rare Case of Isolated Duodenal Crohn’s Disease. International Journal of Gastroenterology, 6(1), 18-21. https://doi.org/10.11648/j.ijg.20220601.14

Copy | Download

ACS Style

Mohammed Ali; Hind Awad; Maurice Murphy; Ashraf Morcos. A Rare Case of Isolated Duodenal Crohn’s Disease. Int. J. Gastroenterol. 2022, 6(1), 18-21. doi: 10.11648/j.ijg.20220601.14

Copy | Download

AMA Style

Mohammed Ali, Hind Awad, Maurice Murphy, Ashraf Morcos. A Rare Case of Isolated Duodenal Crohn’s Disease. Int J Gastroenterol. 2022;6(1):18-21. doi: 10.11648/j.ijg.20220601.14

Copy | Download

@article{10.11648/j.ijg.20220601.14,
  author = {Mohammed Ali and Hind Awad and Maurice Murphy and Ashraf Morcos},
  title = {A Rare Case of Isolated Duodenal Crohn’s Disease},
  journal = {International Journal of Gastroenterology},
  volume = {6},
  number = {1},
  pages = {18-21},
  doi = {10.11648/j.ijg.20220601.14},
  url = {https://doi.org/10.11648/j.ijg.20220601.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20220601.14},
  abstract = {Crohn’s disease (CD) is an inflammatory bowel disease that is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. However, isolated duodenal involvement is rather extremely rare and diagnosis requires comprehensive clinical evaluation. Herein we present the case of a 55 –year lady who was referred to the gastroenterology team with a working diagnosis of possible malignant gastric outlet obstruction. The lady had no background medical or surgical history apart from being investigated for iron deficiency anemia years back by having gastroscopy and colonoscopy which were not significant. Her son was known to have Crohn’s disease. She was originally admitted to hospital with a history of upper abdominal pain, early satiety and weight loss. There were no bowel symptoms. Apart from iron deficiency anemia, her blood investigations were normal. The CT abdomen and pelvis showed duodenal wall thickening with a stricture but otherwise normal, including normal bowels. She had repeated gastroscopy, dilatation and sampling of the stricture site. The first two samples showed non-specific duodenitis. The diagnosis of isolated duodenal Crohn’s disease was made based on the samples from the third gastroduodenoscopy procedure which showed non-caseating granuloma. She had normal ileocolonoscopy and biopsies. Her fecal calprotectin was 230 micrograms per milligram (50-200). Based on the above findings she was put on a course of steroids and started on a standard dose of Infliximab infusion following negative surveillance to rule out latent Tuberculosis and to exclude other viruses as per protocol. The patient made marked clinical, endoscopic and histological response thereafter. This case emphasizes the challenge of diagnosing duodenal Crohn’s disease which, as above, might require high index of clinical suspicion and repeated sampling. We expect that this case report adds to the existing literature on this subject.},
 year = {2022}
}

Copy | Download

TY - JOUR
T1 - A Rare Case of Isolated Duodenal Crohn’s Disease
AU - Mohammed Ali
AU - Hind Awad
AU - Maurice Murphy
AU - Ashraf Morcos
Y1 - 2022/05/24
PY - 2022
N1 - https://doi.org/10.11648/j.ijg.20220601.14
DO - 10.11648/j.ijg.20220601.14
T2 - International Journal of Gastroenterology
JF - International Journal of Gastroenterology
JO - International Journal of Gastroenterology
SP - 18
EP - 21
PB - Science Publishing Group
SN - 2640-169X
UR - https://doi.org/10.11648/j.ijg.20220601.14
AB - Crohn’s disease (CD) is an inflammatory bowel disease that is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. However, isolated duodenal involvement is rather extremely rare and diagnosis requires comprehensive clinical evaluation. Herein we present the case of a 55 –year lady who was referred to the gastroenterology team with a working diagnosis of possible malignant gastric outlet obstruction. The lady had no background medical or surgical history apart from being investigated for iron deficiency anemia years back by having gastroscopy and colonoscopy which were not significant. Her son was known to have Crohn’s disease. She was originally admitted to hospital with a history of upper abdominal pain, early satiety and weight loss. There were no bowel symptoms. Apart from iron deficiency anemia, her blood investigations were normal. The CT abdomen and pelvis showed duodenal wall thickening with a stricture but otherwise normal, including normal bowels. She had repeated gastroscopy, dilatation and sampling of the stricture site. The first two samples showed non-specific duodenitis. The diagnosis of isolated duodenal Crohn’s disease was made based on the samples from the third gastroduodenoscopy procedure which showed non-caseating granuloma. She had normal ileocolonoscopy and biopsies. Her fecal calprotectin was 230 micrograms per milligram (50-200). Based on the above findings she was put on a course of steroids and started on a standard dose of Infliximab infusion following negative surveillance to rule out latent Tuberculosis and to exclude other viruses as per protocol. The patient made marked clinical, endoscopic and histological response thereafter. This case emphasizes the challenge of diagnosing duodenal Crohn’s disease which, as above, might require high index of clinical suspicion and repeated sampling. We expect that this case report adds to the existing literature on this subject.
VL - 6
IS - 1
ER -

Copy | Download

Author Information

Mohammed Ali

Gastroenterology Department, University Hospital Waterford, Waterford, Ireland
Hind Awad

Gastroenterology Department, University Hospital Waterford, Waterford, Ireland
Maurice Murphy

Histopathology Department, University Hospital Waterford, Waterford, Ireland
Ashraf Morcos

Gastroenterology Department, University Hospital Waterford, Waterford, Ireland

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Mohammed Ali, Hind Awad, Maurice Murphy, Ashraf Morcos. (2022). A Rare Case of Isolated Duodenal Crohn’s Disease. International Journal of Gastroenterology, 6(1), 18-21. https://doi.org/10.11648/j.ijg.20220601.14

Copy | Download

ACS Style

Mohammed Ali; Hind Awad; Maurice Murphy; Ashraf Morcos. A Rare Case of Isolated Duodenal Crohn’s Disease. Int. J. Gastroenterol. 2022, 6(1), 18-21. doi: 10.11648/j.ijg.20220601.14

Copy | Download

AMA Style

Mohammed Ali, Hind Awad, Maurice Murphy, Ashraf Morcos. A Rare Case of Isolated Duodenal Crohn’s Disease. Int J Gastroenterol. 2022;6(1):18-21. doi: 10.11648/j.ijg.20220601.14

Copy | Download

@article{10.11648/j.ijg.20220601.14,
  author = {Mohammed Ali and Hind Awad and Maurice Murphy and Ashraf Morcos},
  title = {A Rare Case of Isolated Duodenal Crohn’s Disease},
  journal = {International Journal of Gastroenterology},
  volume = {6},
  number = {1},
  pages = {18-21},
  doi = {10.11648/j.ijg.20220601.14},
  url = {https://doi.org/10.11648/j.ijg.20220601.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20220601.14},
  abstract = {Crohn’s disease (CD) is an inflammatory bowel disease that is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. However, isolated duodenal involvement is rather extremely rare and diagnosis requires comprehensive clinical evaluation. Herein we present the case of a 55 –year lady who was referred to the gastroenterology team with a working diagnosis of possible malignant gastric outlet obstruction. The lady had no background medical or surgical history apart from being investigated for iron deficiency anemia years back by having gastroscopy and colonoscopy which were not significant. Her son was known to have Crohn’s disease. She was originally admitted to hospital with a history of upper abdominal pain, early satiety and weight loss. There were no bowel symptoms. Apart from iron deficiency anemia, her blood investigations were normal. The CT abdomen and pelvis showed duodenal wall thickening with a stricture but otherwise normal, including normal bowels. She had repeated gastroscopy, dilatation and sampling of the stricture site. The first two samples showed non-specific duodenitis. The diagnosis of isolated duodenal Crohn’s disease was made based on the samples from the third gastroduodenoscopy procedure which showed non-caseating granuloma. She had normal ileocolonoscopy and biopsies. Her fecal calprotectin was 230 micrograms per milligram (50-200). Based on the above findings she was put on a course of steroids and started on a standard dose of Infliximab infusion following negative surveillance to rule out latent Tuberculosis and to exclude other viruses as per protocol. The patient made marked clinical, endoscopic and histological response thereafter. This case emphasizes the challenge of diagnosing duodenal Crohn’s disease which, as above, might require high index of clinical suspicion and repeated sampling. We expect that this case report adds to the existing literature on this subject.},
 year = {2022}
}

Copy | Download