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Crohn's disease presenting as isolated jejunitis years after childhood colitis
1Department of Medicine, Lenox Hill Hospital, New York, New York.
Insights
Crohn's disease can manifest as isolated inflammation of the small intestine (jejunitis) in patients with a prior history of ulcerative colitis. Small bowel imaging is crucial for diagnosing such rare presentations of inflammatory bowel disease.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Inflammatory bowel disease (IBD) encompasses conditions like ulcerative colitis (UC) and Crohn's disease (CD).
- Distinguishing between UC and CD can be challenging, particularly in cases with indeterminate colitis.
Observation:
- A patient with a childhood diagnosis of ulcerative colitis later presented with isolated Crohn's jejunitis.
- This case highlights a rare but significant clinical presentation of CD.
Findings:
- Crohn's disease should be suspected in patients with segmental small bowel inflammation and a history of IBD involving the colon.
- Small bowel series are indicated for indeterminate colitis and may be beneficial periodically for all colonic IBD patients.
Implications:
- Early consideration of CD in IBD patients with small bowel symptoms is vital for accurate diagnosis.
- Periodic small bowel imaging can aid in monitoring and managing IBD patients, potentially identifying disease progression or atypical presentations.
Abstract:
We present a case of a patient who had documented ulcerative colitis as a child and later presented with isolated Crohn's jejunitis. Although rare, Crohn's disease must be considered in those patients with segmental inflammation of the small bowel and a prior history of inflammatory bowel disease involving the colon. Patients with colitis that do not show specific criteria for either ulcerative colitis or Crohn's disease should be classified as indeterminant colitis, and a small bowel series is indicated. It may be indicated to obtain a small bowel series in patients with any form of colonic inflammatory bowel disease, periodically, after diagnosis.