A Case Report and Literature Review of Rectosigmoid Crohn’s Disease: A Diagnostic Pitfall Ultimately Leading to Spontaneous Colonic Perforation

Abstract

Inflammatory bowel disease (IBD) is a chronic condition that affects the gastrointestinal tract, with ulcerative colitis (UC) and Crohn's disease (CD) as the two major entities. While these conditions share some similarities in clinical presentation, they have distinct histopathological features. UC is a mucosal disease affecting the left colon and rectum, while CD can affect any part of the gastrointestinal tract and all layers of the bowel wall. Accurate diagnosis of UC and CD is important for effective management and prevention of complications. However, distinguishing between the two conditions based on limited biopsy specimens or atypical clinical presentations can be challenging. We present a case of a patient diagnosed with UC based on a single endoscopic biopsy from the sigmoid colon, who later presented with colonic perforation and was found to have CD on the colectomy specimen. This case emphasizes the importance of clinical guidelines when dealing with any patient of suspected IBD, considering alternative diagnoses in patients with atypical presentations and the need for careful clinical, endoscopic, and histological evaluation to make an accurate diagnosis. Delayed or missed diagnosis of CD can lead to significant morbidity and mortality.

Polybacterial Iliopsoas Muscle Abscess as an Indication for Early Diagnosis of Crohn\'s Disease

“…Several cases of CD with atypical presentations have been reported: a case with poor systemic and gastrointestinal signs for CD other than fever [ 18 ], cases with lesions located in only the large intestine [ 19 , 20 ], and cases with atypical or rare extra-gastrointestinal signs of CD [ 21 – 25 ]. When lesions are located in only the large intestine, it can be difficult to distinguish CD from ulcerative colitis [ 19 ]. The clinical manifestations of a CD case localized to the appendix are similar to those of acute appendicitis, and a diagnosis of CD is possible only by histopathological examinations [ 20 ].…”