Crohn’s disease co-existing with bleeding peptic ulcer disease - a case report

Abstract

Crohn’s disease is a chronic idiopathic inflammatory condition of the gastrointestinal tract, which rarely affects the oesophagus and stomach together. The usual sites of involvement are the terminal ileum and proximal colon. It is rarer still for gastric Crohn’s disease to present for the first time with haematemesis resulting from acute upper gastrointestinal haemorrhage, especially in an African setting where the disease is thought to be rare. Oesophageal Crohn’s disease is usually asymptomatic for a long period of time, and may come to medical attention when dysphagia or complications such as stricture or fistula occur in the oesophagus, or when extra-oesophageal manifestations occur. We present a 67 year old Nigerian farmer who was brought into our emergency room at the Irrua Specialist Teaching Hospital, Irrua, from his farm with a history of sudden onset haematemesis. The clinical diagnosis was moderate to severe upper gastrointestinal haemorrhage secondary to non-steroidal anti-inflammatory drug use. He improved on medical treatment, including blood transfusion. Upper gastrointestinal endoscopic diagnosis was peptic ulcer disease of the oesophagus and stomach and a small hiatus hernia. However, histology of biopsied specimens from the oesophagus and stomach showed typical multiple non-caseating granulomas with associated features of chronic inflammation in keeping with Crohn’s disease.

Keywords: Crohn’s disease, Oesophagus, Stomach, Upper gastrointestinal tract bleeding