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


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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


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