Ovarian involvement in Crohn´s disease: A rare complication.

BACKGROUND: The transmural condition of Crohn's disease predisposes to fistulae or abscesses. The internal fistulae incidence is about 15%. Among them, enteroovarian fistula is rarely described on the literature. Herein, the authors present three cases of enteroovarian fistulas. CASE REPORTS: Two women are diagnosed with ileal Crohn's disease that presented a pelvic abscess diagnosed by ultrasound and CT. On surgery, an inflammatory mass involving the ileum and the ovary was found. The third woman was operated because of a tuboovarian abscess and was diagnosed with ileal Crohn's disease afterwards. In the three cases, the histopathological analysis of the ovary showed granulomas with abscess compatible with Crohn's disease. In one of the cases, multinucleated giant cells were found in the foreign body reaction to vegetable matter. A right ileocolectomy and an adnexectomy were performed in all three cases. No further involvement of the contralateral ovary or other gynaecological complications was observed. DISCUSSION: The treatment of Crohn's disease complications should be individualised. In the case of ovarian involvement, surgical treatment should include adnexectomy.

Afectación ovárica en la enfermedad de Crohn: una complicación rara / Ovarian involvement in Crohn´s disease: a rare complication

Introducción: la naturaleza transmural de la enfermedad de Crohn predispone a fístulas o abscesos. La incidencia de las fístulas internas está alrededor del 15%. Entre ellas, las fístulas enteroováricas son raramente descritas en la literatura. Se presentan tres casos de fístulas enteroováricas. Casos clínicos: dos mujeres diagnosticadas de enfermedad de Crohn ileal presentaron un absceso pélvico que fue diagnosticado mediante ecografía y TC. En la cirugía se halló una masa inflamatoria que afectaba al íleon y al ovario. La tercera mujer fue operada por un absceso tuboovárico y diagnosticada posteriormente de enfermedad de Crohn ileal. En los tres casos, el análisis anatomopatológico del ovario demostró la existencia de granulomas con abscesos compatible con la enfermedad de Crohn. En uno de los casos se hallaron células gigantes multinucleadas como reacción a cuerpo extraño, tratándose de material vegetal. En los tres casos se realizó una ileocolectomía derecha y una anexectomía. En el seguimiento no se ha observado afectación alguna del ovario contralateral, ni otras complicaciones ginecológicas. Discusión: el tratamiento de las complicaciones de la enfermedad de Crohn debe ser individualizado. En caso de afectación ovárica, el tratamiento quirúrgico debe incluir la anexectomía (AU)

Background: The transmural condition of Crohn’s disease predisposes to fistulae or abscesses. The internal fistulae incidence is about 15%. Among them, enteroovarian fistula is rarely described on the literature. Herein, the authors present three cases of enteroovarian fistulas. Case reports: Two women are diagnosed with ileal Crohn’s disease that presented a pelvic abscess diagnosed by ultrasound and CT. On surgery, an inflammatory mass involving the ileum and the ovary was found. The third woman was operated because of a tuboovarian abscess and was diagnosed with ileal Crohn’s disease afterwards. In the three cases, the histopathological analysis of the ovary showed granulomas with abscess compatible with Crohn’s disease. In one of the cases, multinucleated giant cells were found in the foreign body reaction to vegetable matter. A right ileocolectomy and an adnexectomy were performed in all three cases. No further involvement of the contralateral ovary or other gynaecological complications was observed. Discussion: The treatment of Crohn's disease complications should be individualised. In the case of ovarian involvement, surgical treatment should include adnexectomy (AU)