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Case 183

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A 29-year-old male patient presented a three-year history of diarrhea, progressing with 10 kg weight loss in the past two years. Currently, he evacuates about 10 times a day, with liquid to pasty faeces containing food debris, denies presence of blood or mucus. There is a voluminous defecation associated with urgency and tenesmus. A colonoscopy was requested as well as a opaque enema.

According to the clinical history and exams, the most likely diagnosis is:

a) Ulcerative colitis

25%

b) Irritable bowel syndrome

25%

c) Crohn's disease

25%

d) Familial adenomatous polyposis

25%
   

Image analysis

 

Image 1: Lesion at the ileocecal valve, caecum and terminal ileum with deforming aspect and fistula formation (blue arrow). The image also shows areas of fibrotic retraction and pseudopolyps formation, giving the appearance of cobblestones (green arrow).

 

Image 2: Stenotic lesion with mucosal disorganization at caecum, ileocecal papilla and distal ileum (blue arrow).

Highlights

- Crohn's disease occurs worldwide and is more common in England, USA and Scandinavian countries.

- It has a higher prevalence in Caucasians females and is manifested at any age, being more frequent between 20 and 40 years old.

- Although the mechanisms and etiology are unknown, it is believed that an abnormal immune response to bacterial microbiota of the bowel lumen is involved in this process.

- The diagnosis is based on clinical data, imaging and pathological study.

- The drug or surgical treatment depend on the location of the disease, severity of presentation, complications and response to drug therapy.

References

- Brasileiro Filho, G. (Org). Bogliolo Patologia.  8ª edição. Rio de Janeiro: Guanabara Koogan, 2011.

-Goldman, L.; Ausiello, D. Cecil Medicina. Sudré, A. P. (tradutor). 23ª edição. Rio de Janeiro: Elsevier, 2009.

-López, M.; Laurentys-Medeiros, J. Semiologia Médica: As Bases do Diagnóstico Clínico.  5ª edição. Rio de Janeiro: Revinter, 2004. 

- Sociedade Brasileira de Coloproctologia, Colégio Brasileiro de Cirurgia Digestiva, Sociedade Brasileira de Patologia, Colégio Brasileiro de Radiologia, PDF. Available at: <http://www.projetodiretrizes.org.br/8_volume/28-doenca.pdf> Accessed July 23, 2014.

Authors

Breno Afonso Couto Soares, 4th year medical student at UFMG. E-mail: breno.c.soares[at]gmail.com

Gustavo Remigio Gomes, 4th year medical student at UFMG. E-mail: gustavo.rg92[at]hotmail.com

Fábio Mitsuhiro Satake. 4th year medical student at UFMG, e-mail: fabiosatake[at]gmail.com

Lucas Vieira Rodrigues, 6th year medical student at UFMG, e-mail: lucasvrvr[at]gmail.com

Supervisor

Cláudia Alves Couto, professor at the Department of Clinical Medicine at UFMG School of Medicine.

E-mail: cacouto[at]uol.com.br

Reviewers

Letícia Horta, Luanna Monteiro, André Guimarães, Hércules Riani and professor Viviane Parisotto.

Translated by

Luísa Bernardino Valério, 3rd year medical student at UFMG. E-mail: luisabernardino[at]gmail.com

 

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