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• W86245103 abstract "I mages I n E mergency M edicine A Food Impaction in Crohn’s Ileal Stricture Akira Hokama, MD, PhD* Kazuto Kishimoto Yasushi Ihama Hiroshi Chinen Fukunori Kinjo Jiro Fujita First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan Supervising Section Editor: Sean Henderson, MD Submission history: Submitted August 11, 2009; Revision Received August 28, 2009; Accepted September 14, 2009 Reprints available through open access at http://escholarship.org/uc/uciem_westjem [West J Emerg Med. 2010; 11(1):106.] Figure. Computed tomography scan showing a circumlinear food obstruction (arrow) in an ileal stricture with wall thickening. A 47-year-old man with a four-year history of ileo-colonic Crohn’s disease (CD) presented with abdominal pain and vomiting. On examination, his temperature was 38.2 o C and a distended and generalized tender abdomen without peritoneal signs was noted. Laboratory tests revealed an increased white blood cell count of 10,000/mm 3 and a C-reactive protein of 6.2 mg/dl. A plain abdominal radiograph revealed air-fluid levels in the small intestine. A computed tomography (CT) scan disclosed a circumlinear obstruction (arrow) in an ileal stricture with wall thickening (Figure 1). When questioned, the patient stated that his previous dinner consisted of dried cuttlefish and vegetable roots, which might be difficult to digest. Gastrointestinal decompression with nasoenteric tube and antibiotic treatment resolved his symptoms. The patient remained well and was discharged with maintenance infliximab treatment. This case is an important reminder that CD patients are potentially at a greater risk of bowel obstruction with less digestible food. In other rare instances, bowel obstruction by Western Journal of Emergency Medicine food, fruit pits, phytobezoar or foreign bodies has actually led physicians to the diagnosis of CD. 1-3 In these cases, a CT scan has been the key in assessing the bowel obstruction, providing a clear identification of the anatomical site to help identify the cause. Address for Correspondence: Akira Hokama, MD, PhD. First Department of Internal Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. Email: hokama-a@med.u-ryukyu.ac.jp REFERENCES Kaufman D, Lazinger M, Fogel S, et al. Fruit pit obstruction leading to the diagnosis of Crohn’s disease. Am J Surg. 2001; 182:530. Shedda S, Frizelle F. Images in clinical medicine. Crohn’s disease and an olive. N Engl J Med. 2006; 355:e22. Slim R, Chemaly M, Yaghi C, et al. Silent disease revealed by a fruit-- ileal obstruction. Gut. 2006; 55:181-90. Volume XI, no . 1 : February 2010" @default.
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• W86245103 date "2010-02-01" @default.
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• W86245103 title "A food impaction in Crohn's ileal stricture." @default.
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