Crohn's Disease and a Gastrointestinal Stromal Tumor in an 81-Year-Old Man - A Rare Coincidence

 

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Abstract

We describe an 81-year old man presenting with ileus and two rare, pathologically distinct entities: gastrointestinal stromal tumor (GIST) and Crohn's disease. Within Meckel's diverticulum a polypous tumor, 3 cm in diameter, with preserved lumen was found. In the area of the terminal ileum, coecum and colon ascendens inflamed bowel loops were fixed together with fibrous adhesions. Partial resection of the ileum with end-to-end anastomosis and right hemicolectomy with resection of the terminal ileum and end-to-end ileotransverse anastomosis were performed. Pathohistological and immunohistochemical examination revealed the polypous tumor as GIST. Changes in terminal ileum, coecum and colon ascendens were referred as Crohn's disease. Although adenocarcinoma is well known in chronic, long-standing inflammatory bowel disease, other primary intestinal tumors are rare in those patients. Furthermore, Crohn's disease can be a part of differential diagnosis of ileus, also in such an old man.

Zusammenfassung

Wir beschreiben einen 81-jährigen Patienten mit Ileus und 2 seltenen pathologischen Befunden: einem gastrointestinalen Stromatumor und einem Morbus Crohn. Bei der Operation fand sich in einem Meckel'schem Divertikel ein polypöser Tumor von 3 cm Durchmesser, der sich als gastrointestinaler Stromatumor herausstellte und das Darmlumen nicht kompromittierte. Zusätzlich imponierten im terminalen Ileum, Zökum und Kolon ascendens entzündete Darmschlingen, die fibröse Adhäsionen bildeten und für den Ileus verantwortlich waren. Es wurde das Meckel'sche Divertikel mit dem Ileum reseziert und eine End-zu-End-Anastomose durchgeführt, zusätzlich erfolgte eine rechtsseitige Hemikolektomie. Die pathohistologische Untersuchung bestätigte den gastrointestinalen Stromatumor im Meckel'schen Divertikel. Die Veränderungen im terminalen Ileum, Zökum und Kolon ascendens waren dem Morbus Crohn zuzuschreiben. Obwohl die Koinzidenz von einem Adenokarzinom bei lang dauerndem Morbus Crohn bekannt ist, werden bei diesen Patienten nur selten intestinale Tumore anderer Genese gefunden. Unser Fall zeigt des Weiteren, dass auch ein Morbus Crohn in die Differentialdiagnose „Ileus” beim sehr alten Patienten einbezogen werden muss.

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Prof. Dr. A. D.Chief of the Department of Digestive Surgery 

Clinical Hospital Center Rijeka

Kresˇimirova 42

51000 Rijeka

Croatia

Phone: 0 03 85/51 65 86 57

Fax: 0 03 85/51 21 37 34

Email: arsen.depolo1@ri.htnet.hr