Upper gastrointestinal tract involvement in Crohn's disease: A case report
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Updated: Nov 8, 2025
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Michael Orrell1, Cas van 't Hullenaar2, Jonathan Gosling3
1Medical Sciences Division, University of Oxford, Oxford, OX3 9DU, UK.
Insights
Crohn's disease can affect the upper GI tract, causing rare strictures. A Roux-en-Y bypass successfully treated a patient with obstructive upper gastrointestinal Crohn's disease.
Area of Science:
- Gastroenterology
- Surgical Management
- Inflammatory Bowel Disease
Background:
- Crohn's disease (CD) commonly affects the distal gastrointestinal tract.
- Upper gastrointestinal (GI) involvement in CD can lead to strictures, with limited surgical literature on management.
- Obstructive upper GI manifestations of CD are rare and necessitate specialized care.
Observation:
- A 39-year-old male with a 20-year history of CD presented with symptoms of upper GI obstruction.
- Imaging revealed a long duodenal stricture with proximal dilation, without acute inflammation.
- The patient underwent a Roux-en-Y bypass to alleviate obstructive symptoms.
Findings:
- Surgical intervention, such as Roux-en-Y bypass, can effectively manage obstructive upper GI Crohn's disease.
- Careful preoperative planning and risk-benefit assessment are crucial for positive patient outcomes.
- Optimal treatment strategies for obstructive upper GI CD require further evidence.
Implications:
- This case highlights the importance of considering upper GI involvement in Crohn's disease.
- Surgical options should be carefully evaluated for complex cases of upper GI strictures in CD.
- Further research is needed to establish evidence-based guidelines for managing this rare complication.
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.
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