RESUMEN
A 25-year-old male patient who had a brother with Crohn's disease was referred to our clinic with bloody diarrhea and crampy abdominal pain. After a plain erect abdominal X-ray, enteroclysis was performed, followed by abdominopelvic CT. Besides the radiological features of CD, both enteroclysis and CT revealed a big polypoid filling defect in the small intestine. The patient was surgically treated and the histopathology of the specimen revealed a giant fibroid polyp superimposed on CD, an extremely rare complication heretofore unmentioned in the radiology literature. In this report we discuss the role of enteroclysis in the diagnosis of complicated cases of long-standing CD. In addition, we also shed light on the importance of both enteroclysis and CT, with their complementary findings, in the radiological diagnosis of rare complicated cases of CD.
Asunto(s)
Enfermedad de Crohn/complicaciones , Neoplasias del Íleon/complicaciones , Pólipos Intestinales/complicaciones , Intususcepción/etiología , Adulto , Sulfato de Bario/administración & dosificación , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Enema , Humanos , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/patología , Neoplasias del Íleon/cirugía , Pólipos Intestinales/diagnóstico por imagen , Pólipos Intestinales/patología , Pólipos Intestinales/cirugía , Intususcepción/diagnóstico por imagen , Intususcepción/cirugía , Masculino , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Conventional abdominal CT and Ultrasonography were not adequate for the immediate assessment of a closed perforation of the small intestine showing continuity. For definitive diagnosis of the main pathology, we advise enteroclysis. METHODS: All patients had non-traumatic small bowel perforation and had many diagnostic procedures including conventional abdominal CT and ultrasonography, but did not get a positive result from them. Following the enteroclysis, it was obvious that there existed a closed small bowel perforation with continuity. RESULTS: The first patient had fistula and interloop pouch filled with contrast in pelvis minor and perforations in small intestine and cecum. The second patient had closed perforation showing continuity in the level of ileum and the third patient had a pouch showing continuity in the ileum and a fistula in ileum. All patients had operation; the first one had a Crohn's disease and discharged postoperatively on 16th day, but the second one having ileal tumor was lost postoperatively due to pulmonary embolism and the third one having Non-Hodgkin Lymphoma was lost postoperatively due to sepsis. CONCLUSION: Conventional techniques were not sufficient to classify the main pathology in these cases, but enteroclysis revealed good results in diagnosis of the main event, and does not cause a delay in diagnosis.