| Theme |
Atypical cases of inflammatory bowel disease diagnosed with difficulty |
| Title |
Two cases of Crohn's disease and difficulties with diagnosis |
| Author |
Kazuo Ohtsuka |
Department of Gastroenterology and Hepatology |
| Author |
Toshimitsu Fujii |
Department of Pathology, Tokyo Medical and Dental University |
| Author |
Kento Takenaka |
Department of Pathology, Tokyo Medical and Dental University |
| Author |
Katsuyoshi Matsuoka |
Department of Pathology, Tokyo Medical and Dental University |
| Author |
Masakazu Nagahori |
Department of Pathology, Tokyo Medical and Dental University |
| Author |
Maiko Kimura |
Department of Pathology, Tokyo Medical and Dental University |
| Author |
Syohei Tomii |
Department of Pathology, Tokyo Medical and Dental University |
| Author |
Mamoru Watanabe |
Department of Gastroenterology and Hepatology |
| [ Summary ] |
Diagnosing Crohn's disease (CD) is difficult in some cases which do not exhibit typical endoscopic findings such as longitudinal ulcers or cobblestone appearance. When scrutiny is difficult because of the condition of the patient, diagnosis is also difficult. Definitive diagnosis of these cases are finally made by obtaining surgical specimens. Two cases with small bowel CD lesions which were diagnosed after surgery are presented. The first case was a man in his fifties. There were discrete ulcers and strictures in the ileum, as well as abscesses. Because there were obstructions, full investigation was difficult before surgery. Surgical specimens showed typical longitudinal ulcers on the mesenteric side and noncaseating epithelioid granuloma. This case was diagnosed as being CD from those findings. The second case was a man in his forties. He complained of abdominal pain and diarrhea at the onset. Colonoscopy did not detect typical findings associated with CD. Round ulcers in the nasal cavity, oral mucosa, and pharynx were observed. Behcet's disease was suspected. Three years from the onset, partial resection of the ileum was performed. Surgical specimens showed typical longitudinal ulcers on the mesenteric side and an accumulation of histiocytes resembling epithelioid granuloma. Finally he was diagnosed as having CD. |