Gastrointestinal Pathology II Case Studies


CASE 2: Crohn's Disease


Clinical History:

A 27-year-old man has had recurrent attacks of abdominal pain, diarrhea, and low-grade fever for several months. He has also developed steatorrhea. Colonoscopy revealed erythema and erosions of the terminal ileum (image 2.1). Radiographic studies demonstrate an enteroenteric fistula that bypassed much of the small intestine, which was the cause of the malabsorption and steatorrhea (image 2.2). He was taken to surgery where a portion of small intestine was resected. The gross specimen is shown in image 2.3. The microscopic appearance is seen in images 2.4 and 2.5).
  1. What is the diagnosis?

    2. This is Crohn's disease, typified by discontinuous small bowel disease which microscopically is transmural and demonstrates granulomas. About 2 to 4 persons per thousand of northern European ancestry are affected by eiher ulcerative colitis or Crohn's disease, which can sometimes be difficult to distinguish.

  2. Could the patient also have colonic involvement?

    3. Yes, about half of patients with small intestinal Crohn's disease will also have colonic Crohn's disease.

  3. What is the course of this disease and what kinds of complications can develop?

    4. The course typically involves intermittent flareups with intervening asymptomatic periods of weeks to months. Compications of the inflammation include fibrosis with stricture leading to obstruction, fistulas to other loops of bowel or to bladder or skin, and malabsorption. Extraintestinal manifestations of Crohn's disease include: erythema nodosum, ankylosing spondylitis, migratory polyarthritis, and sacroilitis. There is a slightly increased risk for small or large bowel carcinoma, but this risk is far less than that in ulcerative colitis.