An unusual presentation of Crohn's disease

Abstract

The first case of an inflamed, discharging urachal remnant associated with granulomatous appendicitis in which the patient was subsequently found to have Crohn's disease is described.

Enterourachal Fistula as an Initial Presentation in Crohn Disease

“…Fistula may form between adjacent bowel loops and any adjacent structure including the retroperitoneum, urinary bladder, vagina, and skin. A fistulous communication between urachus and inflamed bowel from CD is exceedingly rare and only a few cases are reported [123456789101112]. Due to the rarity and nonspecific presentation, the diagnosis of enterourachal fistula can be delayed [9].…”

“…We did a systematic literature search of MEDLINE and Embase databases using the following terms Crohn's disease, inflammatory bowel disease, IBD, urachus, and urachal. We identified descriptions of twelve cases of CD with an associated urachal complication (Table 1) [123456789101112]. In non-English language journal articles, only abstracts were reviewed and included.…”

“…Paşalega et al [14] reported a patient with CD and infected urachal cyst. Including the patient reported here, the total number of CD patients with urachal anomalies reported in the literature since the publication of first case in the year 1980 is seventeen [123456789101112131415].…”

“…The age range of these patients was between 11 to 31 years and the median age was 19 years [123456789101112]. The male-to-female ratio was almost equal.…”

“…The ileocecal region was involved in most patients. The urachal abnormalities described include enterourachal fistula and infected urachal cyst [123456789101112131415]. Radiological imaging modalities such as CT and magnetic resonance imaging (MRI) were helpful in diagnosing urachal anomalies and also helpful in the suspicion of a fistulous complication.…”