Crohn's Disease Complicated by Rare Types of Intestinal Obstruction: Two Case Reports

Abstract

Intestinal obstruction is one of the most common complications of Crohn's disease (CD), jeopardizing the quality of life of patients. Numerous factors may contribute to intestinal obstruction in CD. Thus far, the primary reason has been identified as intestinal fibrosis caused by repeated chronic inflammation during the active phase of CD. Herein, we report two rare complicated CD cases and provide a reference for the clinical diagnosis and treatment of similar patients. Case one involves capsule endoscope retention in the small intestine of one CD patient concurrent with intestinal obstruction. Case two is a CD patient with intestinal obstruction caused by a mesangial hernia and ileal stenosis. Individualized and minimally invasive surgical intervention ultimately resulted in the successful management of these two patients. The two cases serve as an excellent guide for diagnosing and treating CD patients who present with similar symptoms.

Keywords: Crohn’s disease; capsule endoscopy; internal hernia; intestinal obstruction; minimally invasive surgery.

FIGURE 1

CD complicated by small intestinal obstruction with capsule endoscopic incarceration (Case 1). (A) Abdominal plain film: the jejunum in the upper left abdomen was dilated, and the intestinal cavity contained a gas-liquid plane. Metallic shadows could be seen in the overlapping area of the pelvic cavity. (B) Intraoperative exploration: the capsule endoscope is incarcerated in the narrowed proximal ileum (Arrow point). (C,D) The specimen of surgery: the yellow cylinder is capsule endoscope; vascular clamp showing internal fistula.

FIGURE 2

Intestinal obstruction caused by CD combined with internal hernia and ileal stenosis (Case 2). (A–C) CT scans of abdomen: intestinal tract lesions in the right middle and lower abdomen, causing a proximal small intestinal obstruction. (D–F) Endoscopic examination: noticeable mucosal swelling, irregular fissure ulcers, and multiple polypoid hyperplasias in the sigmoid colon (18 cm away from the anus). The intestinal cavity was so narrowed that the endoscope could not pass through it. (G) Intraoperative exploration: the proximal small intestine passed through the transverse mesocolon, causing the formation of the internal hernia. (H–I) The specimen of surgery.