title: Crohn's disease of the terminal ileum: a cheap diagnosis.
abstract: 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.
authors: Department of General Surgery, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, Northern Ireland, UK. modonnell904@hotmail.com
authors: M E
authors: ME
authors: O'Donnell
authors: N
authors: N
authors: Gibson
authors: M A
authors: MA
authors: Sharif
authors: R A J
authors: RA
authors: Spence
authors: J
authors: J
authors: Lee
mesh_terms: 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
references: MedGenMed. 2003 Feb 11;5(1):8
references: 12827069
references: Abdom Imaging. 2000 Sep-Oct;25(5):526-9
references: 10931991
references: Ulster Med J. 2007 Jan;76(1):37-8
references: 17288304
references: Am J Gastroenterol. 1998 Dec;93(12 ):2595-7
references: 9860437
references: Am J Gastroenterol. 1985 Oct;80(10 ):787-9
references: 4036937
references: Z Gastroenterol. 1996 Mar;34(3):173-7
references: 8650970
references: Am J Surg. 2001 Nov;182(5):530
references: 11754864
references: Gut. 2006 Feb;55(2):181, 190
references: 16407383
references: Surg Endosc. 2003 Feb;17(2):351
references: 12436229
references: Arch Surg. 1976 Jul;111(7):773-5
references: 938222
references: JAMA. 1973 Mar 12;223(11):1288
references: 4739341
references: Dis Colon Rectum. 2004 Oct;47(10):1694-8
references: 15540301
references: Am J Emerg Med. 2000 Mar;18(2):192-3
references: 10750930