Crohn's disease without granuloma was regarded as colitis ulcerosa

• Published in: Zeitschrift für Gastroenterologie
• Main Authors: Gelley, A, Lestár, B
• Format: Conference Proceeding
• Language: English
• Published: 04.05.2005
• ISSN: 0044-2771; 1439-7803
• DOI: 10.1055/s-2005-869677

The differential diagnosis of IBD has been the subject of research for decades. The diagnosis of Crohn disease (CD) is based on the loco-regional, transmural and granuloma forming features of inflammation. Recent studies indicate that the granuloma formation is not an absolute criterion of CD. 52 years old smoker patient with IBD was observed, who's illness was diagnosed as colitis ulcerosa (CU) twenty years ago. Frequent reactivation was detected in the first 13 years of his disease, which led to a subileus causing stenos of the sigmoid colon. The patient held totally aloof of the surgical intervention. The initiated trace element supplementation with 5 ASA therapy suspended the earlier detected reactivations. The patient became free from symptoms throughout 5 years. Later pneumaturia was reduced to enterovesical fistula, and repeat symptoms of subileus resulted in patient's permission for operation. The developed fistulas between aboral side of small bowel and sigmoid colon were proved surgically. The stenotising part of sigmoid colon, and 40cm fistulising small bowel were removed. Terminal ileum and rectum were tipped. End-to side ileoascendostomy and colostomy with colon descendent were created. Histological examination of surgical specimens proved the knife-like deep ulcers, fissures with transmural inflammation, without any signs of granuloma. In spite of steroid and immunosuppressive treatment, developed stenos of the large bowel 10cm above the stoma was proved by colonoscopy. Colectomy and ileorectal anastomosis was created definitely. After the operation the patient recovered his normal weight, and staying power. Conclusion: We would like to call the attention for a CU mimicking CD without granuloma formation. The patient care, the adequate internal and surgical therapy, the alimentary supplementation together helps the adequate management of this incurable disease.