CROHN'S DISEASE (Etiology-Pathology-Clinical picture-Investigations-Treatment)

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CROHN'S DISEASE (Etiology-Pathology-Clinical picture-Investigations-Treatment)

m Etiology:Unknown may be auto immune.
m Pathology: An atypical T.B. "Non caseating granuloma" Commonest site is the iliocaecal region. Usually affects multiple parts of intestine with free parts in between "Skip lesions". Regional enteritis was an old name as it may affect any part of the GIT even the stomach and anal canal.
m Clinical picture:
1- Acute form 20%: Gives picture similar to acute appendicitis.
F N.B. Appendectomy ® Fistula.
2- Chronic form 80%:
a) Ulcerative lesion ® Bl./ rectum & diarrhea ® Abd. pain + Mass.
b) Abscess and fistula formation either to skin or int. organs e.g. (U.B. & vagina). In all cases mass may be felt in the Rt. iliac fossa ® chronic intestinal obstruction.
m Investigations:
Barium follow thorough or (Small bowel enema) ® Narrowing at ilio-caecal region "String sign of Kantor "not diagnostic.
mTreatment:
1- Medical treatment:
- Low residue diet - Intestinal antiseptics.
- Correction of anaemia. - Corticosteroids.
2- Surgical treatment:
· Indications: - Failure of medical treatment.
- Presence of obstruction, abscess or fistula.
· Operation:
- If resectable resect the mass but recurrence is high (Rt. hemicolectomy).
- If fixed do ilio transverse colostomy to bypass the obstruction.
SOURCE: DR. AYMAN SALEM'S BOOK
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