Small Bowel Adenocarcinoma Complicating Crohn's Disease

Abstract

Crohn's disease of the small intestine is usually managed by medical therapy with surgery being reserved for obstruction or fistula formation. A patient is described who developed small bowel obstruction due to an adenocarcinoma of the ileum after over twenty years of medical therapy for Crohn's disease, originally diagnosed at a laparotomy for acute abdominal pain. The possibility of malignancy in such long-standing disease should be considered.

Previous Cancer in a Patient with Crohnʼs Disease

“… 3 , 4 Case reports and small series of Crohn's patients have noted that SBA can develop within a stricture or stricturoplasty site, especially when the patient has long-standing disease and has been treated with medical therapy rather than surgery. 5 – 8 Additional factors that have been associated with SBA among patients with Crohn's disease include prolonged treatment with salicylates, longer duration of disease, fistulas, surgically excluded loops of small bowel (after jejunal or ileal bypass), and the use of immunosuppressive medications. 3 , 9 – 16 A study published almost 40 years ago in Archives of Surgery compared SBA in Crohn's disease with SBA not associated with Crohn's disease and noted that those associated with Crohn's (1) occurred more frequently, (2) were discovered at a younger mean age (46 versus 64 yr), (3) were more likely to occur in the ileum, and (4) were less successfully diagnosed and cured.…”