1.A case of complex Crohn's disease with severe complication.
Li TIAN ; Anliu TANG ; Fen LIU ; Qin GUO ; Xiaoyan WANG ; Shourong SHEN
Journal of Central South University(Medical Sciences) 2016;41(4):440-444
Crohn's disease (CD) is a nonspecific chronic intestinal inflammatory disease with unknown etiology. The course of CD is persistent and recurrent. In the progress, CD can come with many complications such as obstruction, fistula formation, perforation, and hemorrhage. The early diagnosis, treatment, and the time of the surgery for CD pose a big controversy and challenge. There was a female patient diagnosed as Crohn's disease with severe complication in department of Gastroenterology of the Third Xiangya Hospital, Central South University. We reported the diagnosis and treatment on this patient. The choice for the medicine and surgury was discussed.
Crohn Disease
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complications
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diagnosis
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therapy
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Female
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Humans
2.A Case of Optic Neuritis Associated with Crohn's Disease.
Sung Hee HAN ; Oh Young LEE ; Sun Young YANG ; Dae Won JUN ; Hang Lak LEE ; Yong Cheol JEON ; Dong Soo HAN ; Joo Hyun SOHN ; Byung Chul YOON ; Ho Soon CHOI ; Joon Soo HAHM ; Min Ho LEE ; Dong Hoo LEE ; Choon Suhk KEE
The Korean Journal of Gastroenterology 2006;48(1):42-45
In Crohn's disease, neurologic complications such as cerebrovascular accident, headache, peripheral neuropathy have been reported sporadically. The pathogenesis of these neurologic complications is still unknown and controversial. We experienced a 22-year-old man, with Crohn's disease accompanied by optic neuritis. Loss of visual acuity was developed during the worsening course of enterocutaneous fistula. After high dose steroid treatment, his visual acuity and neurologic symptoms improved immediately.
Adult
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Crohn Disease/*complications/drug therapy/pathology
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Humans
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Intestinal Fistula/complications
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Male
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Optic Neuritis/*complications/diagnosis
3.Clinical Characteristics at Diagnosis and Course of Korean Patients with Crohn's Disease.
Jong Beom PARK ; Suk Kyun YANG ; Seung Jae MYUNG ; Jeong Sik BYEON ; Yun Jung LEE ; Gin Hyug LEE ; Hwoon Yong JUNG ; Weon Seon HONG ; Jin Ho KIM ; Young Il MIN
The Korean Journal of Gastroenterology 2004;43(1):8-17
BACKGROUND/AIMS: The aim of this study was to evaluate the clinical characteristics and course of Korean patients with Crohn's disease (CD). METHODS: A total of 113 patients who were newly diagnosed as having CD at the Asan Medical Center between October 1989 and December 2001 were included. RESULTS: The male to female ratio was 1.9:1 and the mean age at diagnosis was 24.2 +/- 7.8 years. The disease location was the small bowel in 19.5%, the large bowel in 11.5%, and the both small and large bowels in 69.0% of the patients. Empirical anti-tuberculous medications were administered to 53 cases (46.9%). Major complications of CD were intestinal obstruction (25.7%) and perianal fistula (42.5%). The cumulative remission rate was 75.7% at 1 year and 80.7% at 3 years from diagnosis. The cumulative relapse rate was 30.7% at 1 year and 53.0% at 3 years from remission. The cumulative operation rate was 11.5% at 1 year and 13.1% at 3 years from diagnosis. CONCLUSIONS: There are no differences in the remission and recurrence rates between Korean and Western patients with CD. Although the cumulative operation rate seems to be lower in Korea than in Western countries, the cause of the difference is uncertain. Further studies are needed to determine the characteristics of CD in Korea.
Adolescent
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Adult
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Crohn Disease/complications/*diagnosis/therapy
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English Abstract
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Female
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Humans
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Korea
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Male
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Remission Induction
4.Chinese experts consensus on diagnosis and treatment of non-perianal fistulating Crohn disease.
Chinese Journal of Gastrointestinal Surgery 2018;21(12):1337-1346
Crohn disease (CD) is a chronic inflammatory disease involving the entire digestive tract and non-perianal fistula is the most serious surgical complication of CD. The goal of treatment is to cure intestinal fistula and intra-abdominal infection, restore the continuity of digestive tract, reduce postoperative recurrence, and improve the quality of life. Evaluation of nutritional status, especially during perioperative period, is important and nutrition support for malnutritional CD patients is necessary. Full assessment of non-perianal fistula and promotion of self-healing is the principal treatment, and surgical drainage combined with enteral nutrition may be a feasible treatment. Trocar puncture with sump drain is recommended to control intra-abdominal abscess. Surgical treatment of enterocutaneous fistula, enteroenteric fistula, enterovesical fistula or enterogynaecological fistula should be considered if medical treatment, nutrition support and surgical drainage fail. Laparoscopic surgery is recommended for patients with mild adhesion of non-perianal fistulating CD. Postoperative medical treatment and risk assessment should be carried out to reduce postoperative recurrence of CD and fistula.
Abdominal Abscess
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etiology
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therapy
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Consensus
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Crohn Disease
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complications
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diagnosis
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therapy
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Drainage
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Humans
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Quality of Life
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Rectal Fistula
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etiology
;
therapy
5.Psoas Abscess with Hip Contracture in a Patient with Crohn's Disease.
Hye Jeong PARK ; Yong Cheol JEON ; Kyeonga LEE ; Tae Jun BYUN ; Tae Yeob KIM ; Chang Soo EUN ; Dong Soo HAN ; Joo Hyun SOHN
The Korean Journal of Gastroenterology 2008;52(3):188-191
A psoas abscess (PA) is a rare clinical entity but is potentially serious condition which presents diagnostic and therapeutic challenges. The diagnosis is frequently delayed due to its variable and nonspecific features and occult clinical course. The delay in diagnosis and treatment of PA is the major poor prognostic factor. We describe herein a case of the sterile psoas abscess complicating Cronh's disease which presented as hip flexion contracture. A 29-year-old man, at remission stage of CD involving ileocolic segment, was admitted due to pain from hip contracture. He had no bloody diarrhea and no abdominal pain. PA was confirmed by abdominal ultrasound. PA with hip contracture was completely treated with surgical excision, irrigation, drainage, and antibiotics. PA was sterile and there was no evidence of a fistulous communication from the bowel. Once suspected, aggressive diagnostic work up and definitive operative intervention is needed.
Adult
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Crohn Disease/*complications/drug therapy
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Diagnosis, Differential
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Drainage
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Hip Contracture/complications/*diagnosis/surgery
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Humans
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Male
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Psoas Abscess/*diagnosis/etiology/ultrasonography
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Tomography, X-Ray Computed
6.The Prevalence of Helicobacter pylori Infection in Korean Patients with Inflammatory Bowel Disease, a Multicenter Study.
Min Jun SONG ; Dong Il PARK ; Sang Jun HWANG ; Eun Ran KIM ; Young Ho KIM ; Byeong Ik JANG ; Suck Ho LEE ; Jeong Seon JI ; Sung Jae SHIN
The Korean Journal of Gastroenterology 2009;53(6):341-347
BACKGROUND/AIMS: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to be lower in individuals with inflammatory bowel disease (IBD) in some Western countries. We investigated H. pylori infection in Korean patients with IBD and any possible associations of H. pylori infection with drug therapy for IBD and the phenotype of Crohn's disease (CD). METHODS: We studied 316 unselected patients with IBD, including 169 ulcerative colitis (UC) patients and 147 with CD, and the control group consisted of 316 age- and gender-matched healthy people who received a comprehensive medical examination for a regular checkup purpose. Infection rates of H. pylori as detected by the urea breath test were compared between the IBD patients and the controls. RESULTS: A statistically significant difference in H. pylori infection rate was noticed between the IBD patients (25.3%) and the controls (52.5%; p<0.001), and between UC (32.0%) and CD patients (17.7%; p=0.04). Among the IBD patients, the age group of <60 and individuals with a history of taking metronidazole (13.0%; p=0.038) or ciprofloxacin (6.7%; p=0.001) were found to have a meaningfully lower infection rate, but those who did not take antibiotics still showed H. pylori infection rate significantly lower than the controls (CD 22.0% vs. UC 33.8% vs. Control 52.5%, p<0.001). With an exception of age, phenotypic characteristics showed no significant relations with H. pylori infection rate in CD patients. CONCLUSIONS: Korean patients with IBD, particularly CD, were found to have a significantly lower H. pylori infection rate than the controls. This association was more evident in those <60 years old, which suggested that H. pylori infection might be deemed to lower possible risks of IBD in younger adults.
Adolescent
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Adult
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Age Factors
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Aged
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Colitis, Ulcerative/complications/diagnosis/drug therapy
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Crohn Disease/complications/diagnosis/drug therapy
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Female
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Helicobacter Infections/complications/diagnosis/*epidemiology
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*Helicobacter pylori
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Humans
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Inflammatory Bowel Diseases/*complications/diagnosis/drug therapy
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Korea
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Male
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Middle Aged
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Phenotype
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Prevalence
7.A Case of Crohn's Disease Presenting with Free Perforation and Portal Venous Gas.
Na Rae HA ; Hang Lak LEE ; Oh Young LEE ; Byung Chul YOON ; Ho Soon CHOI ; Joon Soo HAHM ; Dong Hoo LEE ; Min Ho LEE
The Korean Journal of Gastroenterology 2007;50(5):319-323
Crohn's disease is characterized by its chronic course and transmural inflammation of gastrointestinal tract. The accompanying fibrous reaction and adhesion to adjacent viscera appears to limit the complication of free perforation. The true incidence of free bowel perforation is difficult to assess, however, the anticipated occurrence rate is 1-2% during the course of illness. Moreover, portal venous gas is also an uncommon event in the natural history of Crohn's disease. Portal venous gas occurs when intraluminal gas from the gastrointestinal tract or gas-forming bacteria enters the portal venous circulation. The finding of portal venous gas associated with Crohn's disease does not always mandate surgical intervention. We experienced a case of Crohn's disease presenting with free perforation and portal venous gas. The literatures on the cases with perforation and portal venous gas associated with Crohn's disease were reviewed.
Adult
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Colonoscopy
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Crohn Disease/complications/drug therapy/*pathology
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Diagnosis, Differential
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Embolism, Air/*diagnosis/etiology
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Humans
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Intestinal Perforation/*diagnosis/etiology
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Male
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*Portal Vein
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Tomography, X-Ray Computed
8.Herpes Simplex Virus Duodenitis Accompanying Crohn's Disease.
Byung Hoo LEE ; Wook Hyun UM ; Seong Ran JEON ; Hyun Gun KIM ; Tae Hee LEE ; Wan Jung KIM ; Jin Oh KIM ; So Young JIN
The Korean Journal of Gastroenterology 2013;62(5):292-295
Herpes simplex virus (HSV) is a recognized cause of gastrointestinal infection in immunodeficient patients. Although a few cases of HSV gastritis and colitis in immunocompromised patients have been reported, there are no reports of HSV duodenitis in patients with Crohn's disease (CD). A 74-year-old female was admitted with general weakness and refractory epigastric pain. She had been diagnosed with CD three years ago. Esophagogastroduodenoscopy (EGD) revealed diffuse edematous and whitish mucosa with multiple erosions in the duodenum. Considering the possibility of viral co-infection, cytomegalovirus (CMV) immunohistochemical staining, PCR, and cultures of duodenal biopsies were performed, all of which were negative with the exception of the isolation of HSV in culture. After administration of intravenous acyclovir for 1 week, follow-up EGD showed almost complete resolution of the lesions and the patient's symptoms improved. In CD patients with refractory gastrointestinal symptoms, HSV, as well as CMV, should be considered as a possible cause of infection, so that the diagnosis of viral infection is not delayed and the appropriate antiviral treatment can be initiated.
Acyclovir/therapeutic use
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Aged
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Antiviral Agents/therapeutic use
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Crohn Disease/complications/*diagnosis/virology
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DNA, Viral/analysis
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Duodenitis/complications/*diagnosis
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Endoscopy, Digestive System
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Female
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Herpes Simplex/*diagnosis/drug therapy/virology
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Humans
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Intestinal Mucosa/pathology
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Polymerase Chain Reaction
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Simplexvirus/genetics/*isolation & purification
9.Crohn's Disease Presenting with Erythema Nodosum as an Early Sign: A Case Report.
Seong Joo KANG ; Won MOON ; Moo In PARK ; Kyu Jong KIM ; Jong Bin KIM ; Mi Jung PARK ; Seun Ja PARK ; Hee Kyung CHANG
The Korean Journal of Gastroenterology 2011;58(2):103-106
Erythema nodosum is the most common form of septal panniculitis and the most frequent skin manifestation associated with inflammatory bowel disease, affecting up to 15% of Crohn's disease patients. Since the development of erythema nodosum is closely related with a variety of disorders and condition, it can serve as an important early sign of systemic disease. Here, we present the occurrence of erythema nodosum as an early sign of Cronh's disease in a 16-year-old woman.
Adolescent
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Anti-Inflammatory Agents/therapeutic use
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Azathioprine/therapeutic use
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Colonoscopy
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Crohn Disease/complications/*diagnosis/drug therapy
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Erythema Nodosum/complications/*diagnosis/pathology
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Female
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Humans
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Mesalamine/therapeutic use
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Prednisolone/therapeutic use
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Skin/pathology
10.Septic Pylephlebitis as a Rare Complication of Crohn's Disease.
A Ri SHIN ; Chang Kyun LEE ; Hyo Jong KIM ; Jae Jun SHIM ; Jae Young JANG ; Seok Ho DONG ; Byung Ho KIM ; Young Woon CHANG
The Korean Journal of Gastroenterology 2013;61(4):219-224
Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.
Adolescent
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Anti-Bacterial Agents/therapeutic use
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Anticoagulants/therapeutic use
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Colonoscopy
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Crohn Disease/complications/*diagnosis
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Humans
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Male
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Phlebitis/complications/*diagnosis
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Portal Vein/radiography
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Sepsis/*diagnosis/microbiology
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Streptococcal Infections/diagnosis/drug therapy
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Thrombosis/drug therapy/radiography
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Tomography, X-Ray Computed
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Viridans Streptococci/isolation & purification