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• W2912172040 abstract "Introduction: Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by the formation of non-caseating granulomas. GI involvement is very rare and can occur in a patient with known sarcoidosis or as the initial manifestation of the disease. Small bowel obstruction secondary to sarcoidosis has been described in few case reports. Case Report: A 67 y/o female with previous history of inactive pulmonary sarcoidosis presented with five-day history of nausea, vomiting, abdominal pain, and constipation. Abdominal X ray and CT scan with contrast demonstrated a high grade small bowel obstruction. She was treated conservatively, but as her symptoms progressively worsened, diagnostic laparoscopy was performed and revealed skin tag appearing lesions on the antimesenteric surface of the mid jejunum causing inflammatory adhesions to the mesentery. The bowel was completely viable with no additional lesions in the liver, stomach or visible parts of the colon. Histopathology of tissue biopsy revealed lymphohistiocytic non-caseating granulomatous inflammation with multinucleated giant cells, consistent with sarcoidosis. The patient was discharged on prednisone taper dose with close follow up. Discussion: GI system involvement that is clinically recognizable occurs in 0.1-0.9% of patients with sarcoidosis, with one study revealed small intestine involvement in 0.03% of the cases. It usually occurs in patients in their fifth or sixth decade of life with evidence of multisystem sarcoidosis in approximately one-half of patients. Establishing a definitive diagnosis of GI sarcoidosis depends on three components: 1) Biopsy evidence of non-caseating granulomas in the “symptomatic organ”, 2) Exclusion of other causes of granulomatous disease, particularly mycobacterial, fungal, and parasitic infections, and 3) Clinical, radiographic, and optimally histopathologic evidence of sarcoidosis in at least one other organ system. Treatment of GI sarcoidosis depends on symptomatology. Asymptomatic patients can be monitored without active therapy, while symptomatic patients with organ involvement should be treated with steroid until a response to therapy is noted followed by gradual taper. The optimal duration of steroid treatment for GI sarcoidosis is not known, but experts recommend treating the initial manifestation for at least one year. Other treatments such as surgical intervention may be necessary in patients with bowel obstruction, perforation, or hemorrhage.Figure: Computed tomography (CT) scan of the abdomen demonstrated early complete bowel obstruction at the level of mid-jejunum (A,B). Gastrografin small bowel follow-through demonstrated failure of contrast to pass into the colon (C).Figure: Intraoperative demonstration of the skin tag appearing lesion at the level of mid jejunum causing inflammatory adhesions.Figure: Histopathology of the resected small bowel lesion (A) H&E stain revealed lymphohistiocytic non-caseating granuloma with multinucleated giant cells (black arrow). (B) Negative for acid fast bacilli (AFB) stain. (C) GMS stain negative for fungal infection." @default.
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• W2912172040 date "2017-10-01" @default.
• W2912172040 modified "2023-09-25" @default.
• W2912172040 title "An Uncommon Cause of a Small Bowel Obstruction" @default.
• W2912172040 doi "https://doi.org/10.14309/00000434-201710001-02409" @default.
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