Hospital Federal dos Servidores do Estado do Rio de Janeiro Rio de Janeiro, Rio de Janeiro, Brazil
Edson Jurado da Silva, MD, FACG Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
Introduction: Intestinal ischemia post abdominal trauma can evolve with enteromesenteric infarction with radiological appearance similar to Crohn`s Disease. At least two of the visceral abdominal arteries must be affected. Interruption of blood supply of the intestine may be occlusive or non occlusive. We are going to report a Young patient who came to us for follow up of Crohn`s Disease of the small bowel.
Case Description/Methods: This is a 39 year old White man, who was undergowing unsuccessful treatment for what would be Chron`s disease of the small intestine, probably based on a small bowel follow-through examination that he had previously undergone (Figure A)
He told us that he had been admitted to ICU after a car accident in April 2007 with thoracic (fracture of the sternum, clavicle and several ribs) in addition to blunt abdominal trauma
The abdominal trauma evolved with bloody diarrhea that resolved with conservative treatment following severe abdominal pain worse when lying down.
CT scan of the chest, abdômen and pélvis performed on May 22, 2007 showed the presence of thickening of the ileum. Traumatic pancreatitis was ruled out. CT angiography was considered normal .
Abdominal pain improved and became postprandial with a clear relationship to the quantity and not the quality of food ingested
Barium X Ray of esophagus, stomach , duodenum and small bowel follow- through on July 19, 2007 identified a partially stenosed and ulcerated área extending for about 20 cm in the terminal ileum sparing the ileocecal valve.
On September 12, 2007 a colonoscopy performed by me confirmed a partially stenosed and ulcerated área in the ileum. without involvement of the ileocecal valve. The histopathological examination confirmed small bowel infarction (Figures B, C)
Mesalazine and corticosteroidis were suspended and pentoxifylline 400 mg BID was started with progressive improvement
New colonoscopy performed on March 12, 2008 showed complete resolution of the ulcerated área of the ileum, confirmed by histopathological evaluation (Figures D, E).
Asymptomatic on May 23, 2008, he had repeated small bowell follow-through and now it was normal ( Figure F)
On March 3, 2018, he remained asymptomatic without taking medication.
Discussion: The abdominal pain was related to the amount of food ingested and not to the quality, suggesting the diagnosis of intestinal angina (ischemic enteropathy)
Figure: Radiological, endoscopic, histopathological diagnosis and therapeutic control.
Disclosures:
Edson Jurado da Silva indicated no relevant financial relationships.
Edson Jurado da Silva, MD, FACG. P3295 - Chronic Mesenteric Ischemia Mimicking Crohn's Disease of the Small Intestine, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
