Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2016; 4(6): 146-150
Published online Jun 16, 2016. doi: 10.12998/wjcc.v4.i6.146
Crohn's disease confined to the duodenum: A case report
Dong Jin Song, Il Soon Whang, Hyung Wook Choi, Cheol Yun Jeong, Sung Hoon Jung
Dong Jin Song, Il Soon Whang, Hyung Wook Choi, Cheol Yun Jeong, Sung Hoon Jung, Department of Internal Medicine, Cheil General Hospital and Women’s Healthcare Center, Dankook University College of Medicine, Seoul KS013, South Korea
Author contributions: Song DJ and Whang IS designed the research, analyzed the data and wrote the manuscript; Choi HW, Jeong CY and Jung SH contributed equally to this work; Whang IS critically revised the paper; Whang IS was responsible for approval of the final version of the manuscript.
Institutional review board statement: This case report was reviewed and approved by the Cheil General Hospita Institutional Review Board.
Informed consent statement: The patient involved in this study gave written informed consent authorizing the use and disclosure of her protected health information.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Il Soon Whang, MD, Department of Internal Medicine, Cheil General Hospital and Women’s Healthcare Center, Dankook University College of Medicine, 17, Seoae-ro 1-gil, Jung-gu, Seoul KS013, South Korea. ilsoonw@yahoo.com
Telephone: +82-2-20007406 Fax: +82-2-20007477
Received: January 18, 2016
Peer-review started: January 19, 2016
First decision: February 26, 2016
Revised: March 23, 2016
Accepted: April 20, 2016
Article in press: April 22, 2016
Published online: June 16, 2016
Abstract

Crohn’s disease (CD) can involve any part of the gastrointestinal tract from the mouth to anus. However, gastroduodenal CD is rare with a frequency reported to range between 0.5% and 4.0%. Most patients with gastroduodenal CD have concomitant lesions in the terminal ileum or colon, but isolated gastroduodenal Crohn’s disease is an extremely rare presentation of the disease accounting for less than 0.07% of all patients with CD. The symptoms of gastroduodenal CD include epigastric pain, dyspepsia, early satiety, anorexia, nausea, vomiting, and weight loss. The diagnosis of gastroduodenal CD requires a high level of clinical suspicion and can be made by comprehensive clinical evaluation. Here we report a rare case of isolated duodenal CD not confirmed by identification of granuloma on biopsy, but diagnosed by clinical evaluation.

Keywords: Crohn’s disease, Crohn’s disease confined to the duodenum, Isolated gastroduodenal Crohn’s disease, High level of clinical suspicion, Comprehensive clinical evaluation

Core tip: Most gastroduodenal Crohn’s disease (CD) is associated with involvement of the terminal ileum and colon. CD confined to the stomach or duodenum may occur very rarely. Upper CD is typically confirmed by the presence of granulomas on biopsy, but endoscopic biopsies often fail to reveal granulomas. Thus, diagnosis of gastroduodenal CD requires a high level of clinical suspicion and can be made by comprehensive clinical evaluation if there are no definite histologic findings. This rare case highlights the importance of clinical suspicion and comprehensive clinical evaluation for the diagnosis of isolated gastroduodenal CD.