P0978 - Small Bowel Crohn’s Disease Unmasked by Motor Vehicle Accident

Sierra Anderson, MD, Zoë Post, MD, Sarah Herrera Mercedes, MD
Rush University Medical Center, Chicago, IL

Introduction: Crohn’s disease (CD) is a subtype of inflammatory bowel disease that is characterized by transmural inflammation of the gastrointestinal tract. Patients typically present with diarrhea, abdominal pain, fatigue and weight loss. A quarter of patients have only ileal involvement. Disease flares can be triggered by acute stressors. Here we present a case that was mistaken for small bowel contusion following a motor vehicle accident (MVA).

Case Description/Methods: A 23-year-old presented to the emergency department with abdominal pain with bowel movements and abdominal bruising following a MVA in which the patient was a restrained front passenger with airbag deployment.



Vital signs were normal. Physical exam revealed lower abdominal tenderness and bruising. Relevant labs included: WBC 11.74 K/uL, hemoglobin 14.8 g/dL. Computed tomography abdomen and pelvis (CTAP) demonstrated small bowel wall thickening and fat stranding in the right lower abdominal wall concerning for small bowel contusion given the acuity of his symptoms that occurred after the MVA. He was discharged with outpatient gastroenterology follow-up.



At follow-up, his symptoms had progressed and now included bloating, nausea, vomiting and worsening abdominal pain. He underwent magnetic resonance enterography showing multifocal ileal inflammation and ileal narrowing with upstream dilatation of the small bowel, concerning for partial small bowel obstruction, for which he was admitted.



Inflammatory markers were notable for C reactive protein 14.1 mg/L, ESR 42 mm/hr, fecal calprotectin 327 ug/g. Initial esophagogastroduodenoscopy and colonoscopy were unremarkable and random biopsies of duodenum, terminal ileum and colon were unrevealing. Subsequently, retrograde double balloon enteroscopy was performed showing proximal ileitis and stricture. Biopsies revealed active ileitis and focal cryptitis consistent with CD.

Discussion: This case demonstrates that a flare of CD ileitis triggered by the stress of a MVA was mistaken for small bowel contusion, which is a rare entity, but likely deemed the appropriate diagnosis at the time due to anchoring bias.


Disclosures:


Sierra Anderson, MD, Zoë Post, MD, Sarah Herrera Mercedes, MD. P0978 - Small Bowel Crohn’s Disease Unmasked by Motor Vehicle Accident, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.