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Case report
Crohn’s disease associated adenocarcinoma of ileocaecal region: a miscalculated approach
  1. Royson Dsouza1,
  2. Gigi Varghese2,
  3. Deepa Rebecca Korula3 and
  4. Amit Kumar Dutta4
  1. 1Department of General Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  2. 2Department of General Surgery & Colorectal Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  3. 3Department of Radiodiagnosis, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  4. 4Department of Gastroenterology and Hepatology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  1. Correspondence to Dr Gigi Varghese; gigivargh{at}gmail.com

Abstract

Adenocarcinoma of the bowel is a dreadful sequelae of inflammatory bowel disease that can be difficult to diagnose and has been shown to have poor prognosis. The diagnosis is often made on histopathological examination of the resected specimen for what is suspected to be an exacerbation of the underlying intestinal Crohn’s. A 39-year-old woman who was being treated for small bowel Crohn’s disease for 4 years presented with features of intermittent intestinal obstruction that was refractory to medical therapy. A contrast CT of the abdomen was suggestive of ileocaecal Crohn’s disease, and colonoscopy revealed a stricture at proximal transverse colon with multiple superficial ulcers. She underwent a mesentery sparing right hemicolectomy and had an uneventful recovery. The biopsy, however, was reported to be moderately differentiated adenocarcinoma stage T3N0 with a harvest of four pericolic nodes. Adjuvant chemotherapy was advised, which she deferred. Ten months later, she presented to the emergency room with features of intestinal obstruction. Contrast CT of the abdomen showed thickening at the anastomotic site with intestinal obstruction. On exploratory laparotomy, tumour recurrence was noted at the site of the anastomosis and diffuse peritoneal metastasis. A palliative diversion ileostomy was done due to inoperable obstructing disease. She was then given palliative therapy and subsequently succumbed to the illness. The inclusion of mesentery with the resected specimen in Crohn’s disease has been a debate over many years. Since the preoperative diagnosis of carcinoma of the bowel in Crohn’s disease is challenging, all ileocolic resections should be radical as done in oncological resections. This would yield better oncological safety and may improve survival rates.

  • crohn's disease
  • colon cancer
  • gastrointestinal surgery
  • surgical oncology

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Footnotes

  • Contributors GV and AKD identified the complexity of the case and need for reporting. RD and GV were involved in the preparation of the manuscript and review of the literature. DRK contributed in providing the appropriate radiological images and reporting of the same.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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