A Food Impaction in Crohn’s Ileal Stricture

Author	Affiliation
Akira Hokama, MD, PhD	First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
Kazuto Kishimoto	First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
Yasushi Ihama	First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
Hiroshi Chinen	First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
Fukunori Kinjo	First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
Jiro Fujita	First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan

A 47-year-old man with a four-year history of ileo-colonic Crohn’s disease (CD) presented with abdominal pain and vomiting. On examination, his temperature was 38.2°C and a distended and generalized tender abdomen without peritoneal signs was noted. Laboratory tests revealed an increased white blood cell count of 10,000/mm³ and a C-reactive protein of 6.2 mg/dl. A plain abdominal radiograph revealed air-fluid levels in the small intestine. A computed tomography (CT) scan disclosed a circumlinear obstruction (arrow) in an ileal stricture with wall thickening (Figure 1). When questioned, the patient stated that his previous dinner consisted of dried cuttlefish and vegetable roots, which might be difficult to digest. Gastrointestinal decompression with nasoenteric tube and antibiotic treatment resolved his symptoms. The patient remained well and was discharged with maintenance infliximab treatment.

Figure. Computed tomography scan showing a circumlinear food obstruction (arrow) in an ileal stricture with wall thickening.

This case is an important reminder that CD patients are potentially at a greater risk of bowel obstruction with less digestible food. In other rare instances, bowel obstruction by food, fruit pits, phytobezoar or foreign bodies has actually led physicians to the diagnosis of CD.¹^–³ In these cases, a CT scan has been the key in assessing the bowel obstruction, providing a clear identification of the anatomical site to help identify the cause.

Footnotes

Supervising Section Editor: Sean Henderson, MD
Submission history: Submitted August 11, 2009; Revision Received August 28, 2009; Accepted September 14, 2009
Full text available through open access at http://escholarship.org/uc/uciem_westjem

Address for Correspondence: Akira Hokama, MD, PhD. First Department of Internal Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
Email: hokama-a@med.u-ryukyu.ac.jp

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources, and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.