Crohn's disease of the terminal ileum: a cheap diagnosis.
BACKGROUND
A 29-year-old man was admitted with a 7-day history of progressive non-specific abdominal pain that progressed to small bowel obstruction following ingestion of a 20-pence coin 4-months previously. Colonoscopic retrieval was unsuccessful. A subsequent laparotomy revealed a chronically inflamed thickened terminal ileum with mesenteric fat encroachment necessitating a right hemicolectomy. Histopathological analysis confirmed Crohn's disease with impaction of the 20-pence coin in a distal terminal ileum stricture near the ileo-caecal valve.


CONCLUSIONS
Gastrointestinal foreign body retention should alert the clinician to the presence of an undiagnosed bowel abnormality. Furthermore, failed endoscopic retrieval should be considered as a marker for potential underlying gastrointestinal pathology and a requirement for operative intervention.


CONCLUSIONS
This case describes a rare presentation of Crohn's disease and highlights the need to consider underlying gastrointestinal pathology in patients presenting with a deteriorating clinical condition in the presence of an incidental foreign body.
O'Donnell
M E
ME
Department of General Surgery, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, Northern Ireland, UK. modonnell904@hotmail.com
Gibson
N
N
Sharif
M A
MA
Spence
R A J
RA
Lee
J
J
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology; D005547:Foreign Bodies / Q000150:complications*; D006801:Humans; D007082:Ileum / Q000473:pathology*; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000473:pathology; D007813:Laparotomy; D008297:Male
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