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Case Reports
. 2025 Jul 1;19(1):305.
doi: 10.1186/s13256-025-05333-9.

Crohn's disease onset associated with a ballistic injury to the abdomen in the patient wounded in the war in Ukraine: a case report

Igor Lurin  1   2 , Eduard Khoroshun  3   4 , Vitalii Makarov  3   4 , Volodymyr Nehoduiko  3   4 , Serhii Shypilov  3   4 , Stepan M Chobey  5 , Maksym Gorobeiko  1   6 , Andrii Dinets  7   8   9
Affiliations
Case Reports

Crohn's disease onset associated with a ballistic injury to the abdomen in the patient wounded in the war in Ukraine: a case report

Igor Lurin et al. J Med Case Rep. .

Abstract

Background: The Russo-Ukrainian war is ongoing warfare that is associated with severe injuries among the civil population and military personnel. The aim of this study was to demonstrate a rare case of Crohn's disease manifestation in a combat patient in relation to a ballistic injury to the abdomen in the ongoing war in Ukraine.

Case presentation: A male Caucasian Ukrainian patient 34 years of age received a ballistic injury to the abdomen due to artillery shelling. During the next 22 days, the patient underwent bowel resections with anastomosis as well as several relaparotomies for abdomen revision and lavage. On the 23rd day, the patient was diagnosed with gastrointestinal bleeding. An esophagogastroduodenoscopy showed no signs of active bleeding, but longitudinal ulcers with a cobblestone appearance were detected, which is typical for Crohn's disease. Sulfasalazine at a dose of 3.0 g per day was prescribed to the patient. On the 25th day after the injury, the patient was diagnosed with intestinal bleeding and peritonitis, indicating perforation. At relaparotomy, a perforated ulcer 0.5 cm × 0.5 cm with even and well-defined borders was identified in the jejunum located 10 cm from the Treitz ligament. The ulcer was excised, and the intestine defect was sutured, followed by retrograde intubation of the jejunum. Until the 40th day after the injury, the patient underwent conservative treatment. The patient died on the 40th day after the injury due to multiple organ dysfunction syndrome, which was associated with respiratory failure (pneumonia) and severe intoxication.

Conclusion: Ballistic injury to the abdomen might be a trigger for the onset of Crohn's disease. Patients with intestinal bleeding and stress ulcers should be evaluated for concomitant gastroenterological disorders, and appropriate clinical investigations and management should be applied.

Keywords: Ballistic injury to abdomen; Crohn’s disease; Gunshot injury; Russo-Ukrainian war.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethical Committee at the Kharkiv National Medical University (Kharkiv, Ukraine). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was obtained from the participant. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Contrast-enhanced computed tomography scan of the patient showing gunshot injury to the abdomen with fracture of the right iliac bone and damage to the ascending colon and jejunum. The 1st day after the injury: A axial view and B coronal view of the abdomen during early postoperative period showing no changes in the jejunum wall. The 21st day after the injury C saggital view and D coronal view showing segmenet of jejunum with wall thickening and significant accumulation of the contrast in mucosa layer
Fig. 2
Fig. 2
An macrophotograph of esophagogastroduodenoscopic view of the esophagus showing mucous edema, and longitudinal ulcers with a cobblestone appearance, indicating Crohn’s disease
Fig. 3
Fig. 3
Microphotograph of the ulcer illustrating small giant-cell granulomas on the ulcer bottom (hematoxylin and eosin, 400X objective)
Fig. 4
Fig. 4
Microphotograph of the chronic active colitis (hematoxylin and eosin, 400X objective)
See this image and copyright information in PMC

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References

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