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.
Learning point
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.
Conclusion
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.
Similar content being viewed by others
References
Akhtar S, McElvanna N, Gardiner KR, Irwin ST (2007) Bowel perforation caused by swallowed chicken bones–a case series. Ulster Med J 76:37–8
Brookes MJ, Brind AM (2003) Coin ingestion, an unexpected finding at colonoscopy: case report. Med Gen Med 5:8
Kurkciyan I, Frossard M, Kettenbach J, Meron G, Sterz F, Roggla M et al (1996) Conservative management of foreign bodies in the gastrointestinal tract. Z Gastroenterol 34:173–177
Mendes Ribeiro HK, Nolan DJ (2000) Enterolithiasis in Crohn’s disease. Abdom Imaging 25:526–529
Slim R, Chemaly M, Yaghi C, Honein K, Moucari R, Sayegh R et al (2006) Silent disease revealed by a fruit–ileal obstruction. Gut 55:181–190
Iannuccilli EA, Migliaccio AJ (1973) Regional enteritis with foreign body. JAMA 223:1288
Price JE, Michel SL, Morgenstern L (1976) Fruit pit obstruction. “The propitious pit”. Arch Surg 111:773–775
Wu ML, DeVos WC, Flamm SL (1998) Desiccant recovered, Crohn’s disease discovered. Am J Gastroenterol 93:2595–2597
Kaufman D, Lazinger M, Fogel S, Dutta SK (2001) Fruit pit obstruction leading to the diagnosis of Crohn’s disease. Am J Surg 182:530
Takada M, Kashiwagi R, Sakane M, Tabata F, Kuroda Y (2000) 3D-CT diagnosis for ingested foreign bodies. Am J Emerg Med 18:192–3
Lake JP, Essani R, Petrone P, Kaiser AM, Asensio J, Beart RW Jr (2004) Management of retained colorectal foreign bodies: predictors of operative intervention. Dis Colon Rectum 47:1694–1698
Santamarina R, Yeso VO, Fanelli RD (2003) Colonoscopic retrieval of an appendiceal foreign body: prophylaxis for appendicitis? Surg Endosc 17:351
Faegenburg D, Kryle LS, Kashiwabara H, Doctor NM, Pai P (1985) Intestinal obstruction caused by ingestion of a Heidelberg capsule: report of a case. Am J Gastroenterol 80:787–9
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
O’Donnell, M.E., Gibson, N., Sharif, M.A. et al. Crohn’s disease of the terminal ileum: a cheap diagnosis. Ir J Med Sci 177, 401–403 (2008). https://doi.org/10.1007/s11845-007-0080-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-007-0080-4