TITLE:
Isolated Esophageal Crohn’s Disease with Diffuse Stricture
AUTHORS:
Mohamed Alhaj Moustafa
KEYWORDS:
Isolated Esophageal Crohn’s Disease, Crohn’s Disease, Esophageal Stricture
JOURNAL NAME:
Open Journal of Thoracic Surgery,
Vol.11 No.4,
December
28,
2021
ABSTRACT: Background: Esophageal strictures are considered to be one of the most challenging matters for gastroenterologist, general and thoracic surgeons
in diagnosis and management. They can be grouped into three general categories:
intrinsic diseases, extrinsic diseases, and diseases that disrupt esophageal
peristalsis and/or lower esophageal sphincter (LES) function. Crohn’s disease
(CD) is a very rare cause of esophageal stricture. The prevalence of esophageal
CD ranges from 1% to 2% in adults with CD. It is almost diagnosed lately when
complications have occurred as Strictures, fissures, esophagobronchial
fistulas, and mediastinal abscesses. Case Report: Thirty-nine years old
Kurdish patient, referred to our department for evaluation. Although many consultations during the last two years, the Pt was
still undiagnosed. She had progressive dysphagia, and weight loss of
about 25 kg. She had no other digestive or extra digestive complaint, nor
caustic ingestion history and nor drug history. Chest CT scan and UGI Contrast study revealed
diffuse smooth and regular
esophageal stenosis. Attempts to do upper endoscopy and biopsy failed due to severe stenosis. Prolonged medical history and radiologic
signs exclude malignancy, so esophagectomy with stomach pull-through was done
by the aid of VATS and laparoscopy with excellent results. Pathological finding
of the resected esophagus suggested the diagnosis of Crohn’s disease CD. Conclusions: CD is a rare cause of esophageal stricture and still to be a challenging
early diagnosis due to the low specificity of clinical manifestations (aphthous
ulcers), histologic findings (absence of granulomas), and endoscopic findings.
So many patients have been diagnosed with complications (esophageal strictures,
fistulas) which needed surgical treatment, adding greater morbidity and
mortality. MIS (thoracoscopy-laparoscopy) is valuable in decreasing the
morbidity and mortality and improving the quality of life for those patients.