An Elderly Case of Crohn's Disease Complicated with Internal Fistula and Mass Formation with a Review of the Japanese Literature

Abstract

A case of Crohn's disease in the elderly complicated with internal fistula and mass formation was reported. A 62-year-old woman was admitted to National Toyohashi Hospital on August 16, 1986, with complaints of abdominal pain, pyrexia and diarrhea for two months. Physical examination revealed a goose-egg sized mass in the left lower quadrant of the abdomen. Barium meal examination of the small intestine showed strictures and fistula formation of the jejunum. Angiography showed narrowing and irregularity of the vessels. Malignant tumor of the small intestine could not be ruled out, so that an exploratory laparotomy was done on October 14, 1986. At operation, the jejunum, 70cm from the ligament of Treitz, formed a 5×7cm mass with adhesion and fistula formation. There was a skip lesion at the terminal ileum. Forty cm of the jejunum and 60cm of the ileum were resected, and both of the resected specimens showed longitudinal ulceration, cobblestone appearance and thickening of the wall. Histological examination showed noncaseating granulomas with epitheloid cells and giant cells in the tunica muscularis. Since the report by Komi et al. in 1970, 13 cases of Crohn's disease in the elderly have been reported in Japan up to 1988. We summarized the characteristic findings of Crohn's disease in the elderly in Japan as follows; 1) Clinical symptoms and radiographic findings were similar to those in younger patients. 2) Small bowel involvement was reported in 54%. 3) Surgery was performed in 46%. 4) Preoperative diagnosis was only made in 46% of the elderly patients. 5) There was no associated perianal disease. We conclude that Crohn's disease, which is common in the young, should be considered even in the elderly.