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Barrett G. Levesque, Heidi K. Chua, Sunanda V. Kane, Meckel's ileitis: Not all regional enteritis is Crohn's disease, Inflammatory Bowel Diseases, Volume 17, Issue 6, 1 June 2011, Page E45, https://doi.org/10.1002/ibd.21686
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To the Editor:
Imaging studies and serologies are helpful in the diagnosis of small-bowel Crohn's disease (CD); however, they carry a risk of false-positive diagnoses.1,2 We present a case of obscure overt gastrointestinal bleeding and ileal ulceration with an alternative unifying diagnosis. The patient in this report provided authorization for medical record review for research purposes, and any necessary approval was obtained from the Mayo Clinic Institutional Review Board.
A 60-year-old man had persistent right lower quadrant pain and intermittent maroon stools. He presented to our clinic for management of CD and discussion of biologic therapy. Five years prior to the visit he developed two episodes of brisk hematochezia. The second episode led to hospitalization where his hemoglobin was found to be 8.2 g/dL. He underwent upper endoscopy and ileocolonoscopy where no bleeding source was identified. During the next 4 years he had infrequent maroon stools and right lower quadrant discomfort. Follow-up upper endoscopy, ileocolonoscopy, and tagged red blood scan were normal. Capsule endoscopy suggested ulceration and stricture in the small bowel. Anti-Saccharomyces cerevisiae (ASCA) antibodies were elevated to twice the normal level. The diagnosis of Crohn's ileitis was based on capsule findings and serology results. He was treated with mesalamine and a month of prednisone, and hemoglobin increased to 13 g/dL with a mean corpuscular volume of 85. He presented to our center to discuss alternative treatment strategies for his CD such as biologic therapy.
