[Ileocolic linitis in Crohn's disease]

Area of Science:

• Gastroenterology
• Oncology
• Surgical Pathology

Background:

• Crohn's disease (CD) is a chronic inflammatory condition associated with an increased risk of intestinal cancer.
• Linitis plastica, a rare form of diffuse infiltrating gastric or intestinal adenocarcinoma, is exceptionally uncommon in CD patients.

Observation:

• A case of ileocolonic linitis plastica is presented, occurring 21 years post-ileocecal resection for CD.
• Initial presentation mimicked CD recurrence with a preanastomotic loop stricture causing partial small bowel obstruction.
• Diagnosis was delayed, missed on preoperative assessment and intraoperative findings, and confirmed only by post-resection histology.

Findings:

• The linitis plastica tumor was located in the ileocolonic region.
• Palliative chemotherapy with 5-fluorouracil (5-FU) and folinic acid was administered.
• The patient remained asymptomatic during a 17-month follow-up period.

Implications:

• This case underscores the diagnostic difficulties of malignancy in Crohn's disease patients.
• Malignant transformation should be suspected in CD patients with recurrent active disease signs after a long quiescent phase.
• Early recognition and diagnosis are crucial for managing rare but aggressive tumors like linitis plastica in CD.