Alegbeleye Bamidele Johnson
Department of Surgery, St Elizabeth Catholic General Hospital, Shisong, P.O Box 8, Kumbo - Nso, Bui Division, Northwestern Region, Cameroon.
J Med Case Rep. 2019 Mar 7;13(1):80. doi: 10.1186/s13256-019-1971-5.
A case is reported of innocuous intestinal obstruction requiring surgical intervention that was confirmed to be Crohn's disease histopathologically in a resource-constrained rural mission hospital in Cameroon.
A 70-year man of Kumbo origin from Northwest region of Cameroon with a history of crampy right lower-quadrant abdominal pain, non-bloody, non-mucoid diarrhea alternating with constipation presented to my institution. Abdominal examination of the patient revealed an ill-defined mass in the right iliac fossa and visible peristalsis. An abdominal computed tomographic scan and barium enema study confirmed a complex ascending colonic and cecal tumor. The patient underwent exploratory laparotomy. The intraoperative finding was a huge complex inflammatory mass involving the cecum, terminal ileum, and sigmoid colon. He subsequently had sigmoidectomy with end-to-end sigmoidorectal anastomosis and a cecal resection, and the proximal ascending colon was exteriorized because end mucoid fistula and terminal ileostomy were performed. The histopathological diagnosis confirmed Crohn's disease. The patient subsequently received five courses of adjuvant chemotherapy consisting of azathioprine, methotrexate, mesalamine, and methylprednisolone. He had complete disease remission and subsequently had closure of ileostomy with satisfactory postoperative status. The most recent follow-up abdominal computed tomographic scan and colonoscopy revealed disease-free status. The patient is also currently receiving a maintenance dose of rectal mesalamine and oral omeprazole treatment. He has been followed every 2 months in the surgical outpatient clinic over the last 16 months with satisfactory clinical outcome.
Crohn's disease is uncommon in Africa, and this entity is encountered sparingly. The signs and symptoms of Crohn's disease overlap with many other abdominal disorders, such as tuberculosis, ulcerative colitis, irritable bowel syndrome, and others. Several publications in the literature describe that it is difficult to make an accurate diagnosis of this disease, despite the fact that many diagnostic armamentaria are available to suggest its presence. Most of the patients with Crohn's disease are treated conservatively, and a few may require surgical intervention, especially those presenting with complications such as intestinal obstruction, perforations, and abscess as well as fistula formations, as seen in this index patient. Crohn's disease is considered by many to be a very rare disease in Africa. It is interesting to know that Crohn's disease, which affects mainly young adults, may debut at any age. The rarity and clinical curiosity of this entity suggested reporting of my patient's case. Evidence-based up-to-date information on Crohn's disease is also documented.
本文报道了一例在喀麦隆资源匮乏的农村教会医院发生的，需要手术干预的无明显危害的肠梗阻病例，经组织病理学确诊为克罗恩病。
一名来自喀麦隆西北地区昆博的70岁男性患者，有右下象限腹部绞痛病史，伴有非血性、非黏液性腹泻与便秘交替出现，前来我院就诊。对该患者进行腹部检查时，发现右髂窝有一个边界不清的肿块，并可见蠕动波。腹部计算机断层扫描和钡剂灌肠检查证实升结肠和盲肠有一个复杂的肿瘤。患者接受了剖腹探查术。术中发现一个巨大的复杂炎性肿块，累及盲肠、回肠末端和乙状结肠。随后，患者接受了乙状结肠切除术及乙状结肠直肠端端吻合术和盲肠切除术，由于行末端黏液瘘和回肠造口术，近端升结肠被外置。组织病理学诊断确诊为克罗恩病。患者随后接受了五个疗程的辅助化疗，化疗药物包括硫唑嘌呤、甲氨蝶呤、美沙拉嗪和甲基泼尼松龙。患者疾病完全缓解，随后回肠造口关闭，术后情况良好。最近的腹部计算机断层扫描和结肠镜检查显示无疾病状态。患者目前还在接受维持剂量的直肠美沙拉嗪和口服奥美拉唑治疗。在过去16个月里，患者每2个月在外科门诊接受随访，临床结果令人满意。
克罗恩病在非洲并不常见，这种病例很少见。克罗恩病的体征和症状与许多其他腹部疾病重叠，如结核病、溃疡性结肠炎、肠易激综合征等。文献中的几篇出版物描述，尽管有许多诊断手段可提示该病的存在，但准确诊断这种疾病仍很困难。大多数克罗恩病患者接受保守治疗，少数患者可能需要手术干预，特别是那些出现肠梗阻、穿孔、脓肿以及瘘管形成等并发症的患者，本病例患者即如此。许多人认为克罗恩病在非洲是一种非常罕见的疾病。有趣的是，主要影响年轻人的克罗恩病可能在任何年龄首次出现。鉴于该病例的罕见性和临床特殊性，故报告本患者的病例。本文还记录了基于证据的关于克罗恩病的最新信息。
