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Case Report – Crohn’s Disease

Case Report – Crohn’s Disease. Chisa Yamada, M.D. Case : H02- 41554. 40 years old, female C.C.: abdominal pain

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Case Report – Crohn’s Disease

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  1. Case Report – Crohn’s Disease Chisa Yamada, M.D.

  2. Case : H02- 41554 • 40 years old, female • C.C.: abdominal pain • Clinical history: Patient who has a history of Crohn’s disease for over 12 years admitted to the hospital on 11/08/02 with C.C. for over 2 weeks. CT showed right lower abdominal abscess and small bowel study showed distal ileal narrowing and multiple fistulae formation from ileum to ileum and ileum to cecum. Patient got an operation on 11/29/02.

  3. Gross Description • Twisted segment of ileum and cecum. Ileum measures 51 cm and 2.5 cm, cecum measures 3.5 cm and 4 cm in length and diameter respectively. • 2 ileum to ileum fistulae and 1 ileum to cecum fistula with polypoid mucosal projection and bridging. • Ileum has skip lesion with variable mucosal thickness ranging from 0.3 cm to 0.7 cm. It also has creeping fat, serosa to serosa adhesions and multiple linear ulcerations. • Mucosa on cecum is unremarkable.

  4. Microscopic Findings • Chronic active ileo-colitis with transmural inflammation, fibrosis, deep linear ulcers. • Mild cryptitis and mild architectural distortion. • Granulomas are not identified.

  5. Crohn’s Disease • Incidence : 1-3 / 100,000 in the US • Peak age : 20-40, 60-80 years old • Sex : Female > Male • Race : Whites : non-whites = 3-5 : 1 • Symptoms : diarrhea(rarely bleeding), fever, abdominal pain, dyspepsia, malabsorption, perianal diseases. • Extraintestinalmanifestation : ankylosing spondylitis, iritis, episcleritis, sclerosing cholangitis, erythema nodosum, clubbing of fingers.

  6. Crohn’s Disease • Gross features : aphthoid ulcers, skip lesions, cobble stoning, rectal sparing, longitudinal “railroad track” ulcer or transverse “bear-craw” ulcers, inflammatory polyps, thickening of the wall, strictures, fistulas, abscess, toxic dilatation, carcinoma(rare) • Histological features : Glanulomas, aphthoid ulcers, focal cryptitis, focal chronic infiltration, disproportionate submucosal inflammation, acute terminal ileitis, architectural distortion.

  7. Differential Diagnosis - Gross

  8. Differential Diagnosis - Histology

  9. Differential Diagnosis

  10. References • Gastrointestinal Pathology and Its Clinical Implications, Klaus J. Lewin, p858-903 • Diagnostic Surgical Pathology, 3rd Edition, Stephen S. Steinberg, p1375-1383 • Pathologic Basis of Disease, Ramzi S. Cotlan, p800-806

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