Crohn's Disease of the Terminal Ileum: A Cheap Diagnosis

Ir J Med Sci. 2008 Dec;177(4):401-3. doi: 10.1007/s11845-007-0080-4. Epub 2007 Aug 18.

Abstract

Background: A 29-year-old man was admitted with a 7-day history of progressive non-specific abdominal pain that progressed to small bowel obstruction following ingestion of a 20-pence coin 4-months previously. Colonoscopic retrieval was unsuccessful. A subsequent laparotomy revealed a chronically inflamed thickened terminal ileum with mesenteric fat encroachment necessitating a right hemicolectomy. Histopathological analysis confirmed Crohn's disease with impaction of the 20-pence coin in a distal terminal ileum stricture near the ileo-caecal valve.

Learning point: Gastrointestinal foreign body retention should alert the clinician to the presence of an undiagnosed bowel abnormality. Furthermore, failed endoscopic retrieval should be considered as a marker for potential underlying gastrointestinal pathology and a requirement for operative intervention.

Conclusion: This case describes a rare presentation of Crohn's disease and highlights the need to consider underlying gastrointestinal pathology in patients presenting with a deteriorating clinical condition in the presence of an incidental foreign body.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / etiology
  • Abdominal Pain / pathology
  • Adult
  • Crohn Disease / diagnosis*
  • Crohn Disease / pathology
  • Foreign Bodies / complications*
  • Humans
  • Ileum / pathology*
  • Intestinal Obstruction / diagnosis*
  • Intestinal Obstruction / pathology
  • Laparotomy
  • Male