A Case Report of Crohn's Disease Undergoing Surgery for Pyloric Stenosis

Mikio Imamura, Hiroki Takahashi, Hidemi Yamauchi

Department of Surgery, Sendai National Hospital

A 23-year-old man had been treated for colonic Crohn's disease since 1986. Three years after the onset of the disease, he began to suffer from nausea and vomiting, and had an upper GI series examination which showed an irregular antral mucosa with pyloric stenosis. Gastroendoscopic examination demonstrated a nodular cobblestonelike appearance in the gastric antrum. Histological study of the biopsied specimen obtained from the antral lesion revealed epitheloid granulomas with Langhans'giant cells. From these findings, this condition was diagnosed as pyloric stenosis due to Crohn's disease. Conservative treatment using salazosulfapyridine and elemental diet failed to improve the gastric outlet stenosis, and surgical intervention was elected. As there were severe fibrous adhesions around the gastric antrum and duodenal bulb, a gastrojejunostomy was performed insted of gastric resection. The patient has been well without signs of stomal ulcer or deterioration of Crohn's disease under medical treatment. Crohn's disease with pyloric stenosis is rare, and only 18 cases including this one have been reported in the Japanese literature. Fifteen patients underwent surgery, that is distal gastrectomy in ten cases, and by-pass surgery in five cases.

Key words
pyloric stenosis due to Crohn's disease, by-pass surgery for pyloric stenosis

Reprint requests
Mikio Imamura Department of Surgery, Sendai National Hospital
2-8-8 Miyagino, Miyagino-ku, Sendai, 983 JAPAN

Accepted
September 9, 1992

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