[Duodenal Crohn's disease: diagnostic and therapeutic complexity]

Area of Science:

• Gastroenterology
• Digestive System Diseases
• Inflammatory Bowel Disease

Background:

• Crohn's disease typically affects various digestive tract areas, but duodenal involvement is uncommon.
• Diagnostic challenges arise as duodenal Crohn's can mimic peptic ulcer disease clinically, radiologically, and endoscopically.
• Fistula formation is rare in duodenal Crohn's, unlike other localizations.

Observation:

• A case of duodenal Crohn's disease presented with non-specific symptoms, initially misdiagnosed.
• Standard steroid therapy proved insufficient for disease control.
• The condition progressed, leading to complications including an enterocutaneous fistula.

Findings:

• Histologic examination alone was not definitive for duodenal Crohn's diagnosis.
• Steroid treatment failed to achieve remission or manage complications.
• Combination therapy with azathioprine was highly effective in inducing remission and resolving the enterocutaneous fistula.

Implications:

• Highlights the diagnostic difficulties of rare duodenal Crohn's disease.
• Emphasizes the potential inadequacy of steroids alone for severe or complicated duodenal Crohn's.
• Demonstrates the efficacy of azathioprine in managing refractory duodenal Crohn's and its complications.