Year 2023 / Volume 115 / Number 10
Letter
Isolated Jejunal Crohn's Disease: a challenging diagnosis

582-583

DOI: 10.17235/reed.2022.9423/2022

Cristiana Sequeira, Inês Santos, Sara Lopes, Cristina Teixeira, Ana Luísa Alves, Ana Paula Oliveira,

Abstract
A 27-year-old Nepalese male presented with recurrent abdominal pain accompanied by a lower stool consistency over the past 2 years. These episodes occurred several times a year, lasting 1 to 2 weeks, and resolved spontaneously, after adjustment of diet and/or medication for symptomatic control (e.g., antispasmodics, probiotics). Over the last year, the patient had undergone an extensive diagnostic investigation, which revealed no alterations in the laboratory workup, abdominal scan, esophagogastroduodenoscopy, and colonoscopy, including biopsies of the duodenum, and colon, so the symptoms have been attributed to irritable bowel syndrome. However, the symptoms had become more frequent, so the patient was referred to our gastroenterology department. We repeated and extended the work-up. Laboratory investigations showed an elevated erythrocyte sedimentation rate and faecal calprotectin. The remaining laboratory as well an extensive stool workup for infection were unremarkable. Esophagogastroduodenoscopy and ileocolonoscopy were normal. Small bowel capsule endoscopy revealed jejunal mucosa with lymphangiectasias, pseudopolypoids formations and superficial longitudinal ulcers, these findings were corroborated by the double-balloon enteroscopy, and biopsies showed marked architectural distortion, chronic inflammatory infiltrate, and an epithelioid granuloma. The clinical, endoscopic, biochemical, and histological findings were consistent with isolated jejunal Crohn's disease. The patient started adalimumab with complete remission after one year. We present this case given its exuberant endoscopic findings and due to the difficulty in making the diagnosis due to its rarity, location, and unspecific presentation.
Share Button
New comment
Comments
No comments for this article
References
1. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn's disease. Lancet. 2017 Apr 29;389(10080):1741-1755. doi: 10.1016/S0140-6736(16)31711-1. Epub 2016 Dec 1. PMID: 27914655.
2. Kidambi, T.D., Liang, Y., Motarjem, P. et al. Episodic, severe abdominal pain due to isolated jejunal Crohn’s disease. Clin J Gastroenterol 14, 1084–1089 (2021). https://doi.org/10.1007/s12328-021-01421-7
3. Blancas-Valencia JM, Blanco Velasco G. Concordance between capsule endoscopy and device-assisted enteroscopy in small-bowel lesions. Rev Esp Enferm Dig. 2021 Jan;113(1):76-77. doi: 10.17235/reed.2020.7295/2020. PMID: 33213175.
Related articles

Letter

An unusual cause of abdominal pain in an older female

DOI: 10.17235/reed.2023.9898/2023

Letter

Median arcuate ligament syndrome: a rare cause of abdominal pain

DOI: 10.17235/reed.2023.9404/2022

Digestive Diseases Image

A surprising white thread on a terminal ileoscopy

DOI: 10.17235/reed.2022.9311/2022

Letter

Comb sign in Crohn’s disease

DOI: 10.17235/reed.2022.9132/2022

Letter

Ectopic ACTH syndrome in a patient with Crohn’s disease

DOI: 10.17235/reed.2022.8825/2022

Letter

Pulmonary nodules in a patient with Crohn’s disease

DOI: 10.17235/reed.2022.8499/2021

Digestive Diseases Image

Duodenal-type follicular lymphoma: a silent tumor

DOI: 10.17235/reed.2021.8149/2021

Letter

Adenocarcinoma of the small intestine in Crohn's disease

DOI: 10.17235/reed.2021.8050/2021

Letter

Subacute distal ileitis in a healthy young adult

DOI: 10.17235/reed.2021.7831/2021

Digestive Diseases Image

Celiac trunk segmental arterial mediolysis: a rare cause of arteriopathy

DOI: 10.17235/reed.2020.7143/2020

Letter

Chronic abdominal pain due to mesenteric schwannoma

DOI: 10.17235/reed.2020.6876/2020

Digestive Diseases Image

An unusual association: median arcuate ligament syndrome and nutcracker syndrome

DOI: 10.17235/reed.2019.5997/2018

Case Report

Cannabis intake and intussusception: an accidental association?

DOI: 10.17235/reed.2016.4288/2016

Letter to the Editor

An unusual etiology of abdominal pain in children

DOI: 10.17235/reed.2016.4168/2015

Letter to the Editor

Unusual course of epiploic appendicitis

DOI: 10.17235/reed.2015.3796/2015

Citation tools
Sequeira C, Santos I, Lopes S, Teixeira C, Alves A, Oliveira A, et all. Isolated Jejunal Crohn's Disease: a challenging diagnosis . 9423/2022


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1101 visits.
This article has been downloaded 56 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 13/12/2022

Accepted: 14/12/2022

Online First: 23/12/2022

Published: 09/10/2023

Article Online First time: 10 days

Article editing time: 300 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology