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A patient with anemia of obscure origin: Crohn's disease in disguise

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From Nature Clinical Practice Gastroenterology & Hepatology

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Abstract

Background A 65-year-old white Mediterranean male with a 10-year history of intermittent anemia, who was otherwise completely asymptomatic, was referred to our hospital in March 2004. He had a medical history of beta thalassemia and fecal occult blood tests had occasionally been positive.

Investigations Fecal occult blood test, laboratory investigations, esophagogastroduodenoscopy, colonoscopy with retrograde ileoscopy, mesenteric angiography, small-bowel series, CT scan of the abdomen and pelvis, Meckel's scan, and capsule endoscopy. Laparoscopic surgery followed by macroscopic and microscopic histopathologic examination of samples obtained during the procedure.

Diagnosis Crohn's disease of the small bowel.

Management Laparoscopic segmental small-bowel resection with end-to-end anastomosis. Postsurgical treatment with Pentasa® 4 g a day.

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Figure 1: CT scan of the abdomen of a 65-year-old white Mediterranean male with a long-standing history of anemia.
Figure 2: Capsule endoscopy of the small bowel of a 65-year-old white Mediterranean male with anemia.
Figure 3: Photomicrograph of the small-bowel mucosa and submucosa of a patient with Crohn's disease of the small bowel.

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Author information

Authors and Affiliations

  1. Clinical Fellow in the Department of Medicine at the University of Toronto and a Gastroenterology Fellow at St Michael's Hospital, Toronto, ON, Canada

    Elena Dubcenco

  2. Emeritus Professor of Medicine at the University of Toronto and a Physician at St Michael's Hospital, Toronto, ON, Canada

    Khursheed N Jeejeebhoy

  3. Assistant Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto, Toronto, ON, Canada

    Cathy J Streutker

  4. Assistant Professor in the Department of Medical Imaging at the University of Toronto and a Staff Radiologist at St Michael's Hospital, Toronto, ON, Canada

    Arthur H Zalev

  5. Professor, Emeritus in the Departments of Medicine and Laboratory Medicine & Pathobiology at the University of Toronto,

    M Bernadette Garvey

  6. a Director of the Haematology Laboratory at St Michael's Hospital, Toronto, ON, Canada

    M Bernadette Garvey

  7. Associate Professor of Medicine and Nutritional Sciences at the University of Toronto and a Staff Gastroenterologist in the Division of Gastroenterology at St Michael's Hospital, Toronto, ON, Canada

    Young-In Kim

  8. Assistant Professor in the Department of Medicine at the University of Toronto and a Senior Staff Gastroenterologist at St Michael's Hospital, Toronto, ON, Canada

    Jeffrey P Baker

Authors
  1. Elena Dubcenco
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  2. Khursheed N Jeejeebhoy
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  3. Cathy J Streutker
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  4. Arthur H Zalev
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  5. M Bernadette Garvey
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  6. Young-In Kim
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  7. Jeffrey P Baker
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Corresponding author

Correspondence to Jeffrey P Baker.

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The authors declare no competing financial interests.

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Dubcenco, E., Jeejeebhoy, K., Streutker, C. et al. A patient with anemia of obscure origin: Crohn's disease in disguise. Nat Rev Gastroenterol Hepatol 3, 229–233 (2006). https://doi.org/10.1038/ncpgasthep0449

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  • DOI: https://doi.org/10.1038/ncpgasthep0449

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