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A Case Report of Crohn's Disease with Eccentric Clinical Features and Unusual X-ray and Endoscopic Findings H. Doi 1 , Y. Yamawaki 1 , K. Ohshima 2 , H. Nishio 2 , T. Miyashita 3 1Dept. of Radiology, Gifu University, School of Medicine 21st Dept. of Internal medicine, Gifu University, School of Medicine 3Dept. of Pathology, Gifu University, School of Medicine pp.255-261
Published Date 1978/2/25
DOI https://doi.org/10.11477/mf.1403107224
  • Abstract
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 The patient is a 29-year-old male. In December 1972, he had undergone appendectomy. Since then he frequently complained of some discomfort with mild tenderness at the right lower abdomen. In June 1976, he suffered from severe colicky pain at this region without any onset of melenea or diarrhoea. Alimentery tract X-ray examination revealed marked spastic shrinkage of the cecum and ascending colon. The Bauhin's valve and terminal ileum presented marked stricture, but there was no evidence of obstruction. Barium enema and colonofiberscopy revealed a bilocular elevated lesion at the bottom of the coecum suggesting a submucosal tumor. The surface of the tumor appeared smooth with no evidence of mucosal effacement. There was no evidence of a deep ulceration or of a fistula formation. The terminal ileum involving the ileocecal valve presented a marked narrowing, and the proximal segment adjacent to this stricture was consequently dilated with an irregular unilateral rigidity of the wall.

 In July 1976, partial resection from the distal segment of the ileum to the proximal ascending colon was performed. Small amount of serous ascites was found. There was tight adhesion between the cecum and the terminal ileum. No fistula formation was noted. On the resected specimen, a longitudinal ulcer was found at the terminal ileum. Several small erosions and ulcerations were seen on the region of the ileocoecal valve. Histological study disclosed that transmural inflammation spreads across all layers of the coecum and several fistulas reaches into the mucosa and submucosa. There are small abscesses surrounded by non-caseating epitheloid cell granulation observed in the central portion of the submucosal layers. Regional mesenteric lymph nodes also present non-caseating sarcoid-like granuloma with a few Langhans' giant cells.

 According to the diagnostic criteria of Crohn's disease proposed by the Japanese Society of Gastroenterology, this case may be adopted to the category of this disease, eventhough the clinical features are not enough significant. It is understandable that the clinical features may vary depending on the stage of progress or on individual difference of immunological reaction.


Copyright © 1978, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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