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Gastroduodenal Crohn disease
Insights
Symptomatic stomach and duodenum involvement in Crohn disease is rare but serious, often requiring surgery for relief. Medical management, including intravenous hyperalimentation, proved ineffective in these cases.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Background:
- Crohn disease typically affects the small intestine.
- Gastric and duodenal involvement in Crohn disease is uncommon.
Observation:
- Three young female patients presented with upper gastrointestinal symptoms.
- Symptoms included gastric outlet obstruction and massive hemorrhage.
- Diagnosis was confirmed histopathologically after suggestive imaging.
Findings:
- All patients required surgical intervention for symptom relief.
- Surgical procedures included distal gastrectomy and gastrojejunostomy.
- Medical management, even with intravenous hyperalimentation, was unsuccessful.
Implications:
- Symptomatic upper gastrointestinal Crohn disease often necessitates surgical treatment.
- Early surgical consideration may be crucial for managing severe gastric and duodenal Crohn disease.
- This highlights the need for recognizing and managing rare Crohn disease manifestations.
Abstract:
Symptomatic involvement of the stomach and duodenum is an uncommon manifestation of Crohn disease. Our experience with three young women who had upper gastrointestinal tract symptoms indicates the seriousness of the condition. All three patients required operation for relief of symptoms. Two operations were performed for gastric outlet obstruction and one for massive hemorrhage (a rare complication of gastric involvement). All patients had roentgenographic or gastroscopic evidence suggestive of Crohn disease, and in each the diagnosis was confirmed by histopathologic means. The operative procedures consisted of distal gastrectomy in two cases and gastrojejunostomy in the third. All three patients have or have had evidence of Crohn disease of the small intestine and none of them responded to medical management. (In the most recent case, medical management included intravenous hyperalimentation.) In our experience, symptomatic involvement of the stomach in Crohn disease will not respond to medical treatment and will require surgical measures for relief.