1989 Volume 31 Issue 2 Pages 449-457
A 22-year-old male, was admitted to this hospital in June 1985. He had suffered from diarrea, anorexia, vomiting and weight loss for the past 10 years, diagnosed as gastroduodenal ulcer and undergone medical treatment. An upper GI series showed a pyloroduodenal stenosis and multiple irregular polypoid lesions. In the second portion of the duodenum, there was poor distensibility and mucosal nodularities with pseudodiverticula. Endoscopic view of the stomach revealed the mucosal nodularity or "cobble-stone appearance", fissure ulceration and pyloroduodenal stenosis, and the specimens of the endoscopical polypectomized nodule showed a glanuloma, establishing a diagnosis of Crohn's disease. This patient responded well to elemental diet (ED), salazosulfapyridine (SASP) and predonisolone (PLS), and was discharged in December 1985. In May 1986, he was readmitted because of the same symptoms. After treatment with ED and SASP, these symptoms disappeared and he was discharged in July 1984. He remained well since that time on maintenance dose of SASP, after the cessation of ED therapy. Ten cases of gastroduodenal Crohn's disease including the present one have been reported in Japan. Seven cases were treated surgically and only three cases including this case responded to concervative treatment. Our patient had obvious clinical and endoscopic evidence of pyloroduodenal stenosis. He was given ED, SASP and PLS and has remained free of gastric complaints for over 2 years. We suggest that patients with gastroduodenal Crohn's disease can be treated conservatively with careful madical follow up.
