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Herrick-Reynolds KM, Steinhauser CM, Singla M, Kucera WB, Wind GG, Gerald TS, Altamar HO, O'Donnell MT. Entero-Urachal Fistula: An Unusual Initial Presentation of Penetrating and Stricturing Crohn's Disease. Am Surg 2021:31348211054560. [PMID: 34747235 DOI: 10.1177/00031348211054560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Crohn's disease (CD) has a wide variety of clinical presentations, ranging from abdominal pain to stricture and fistula. Fistulas involving the genitourinary tract can be severe and often require surgical intervention. Given the array of presenting symptoms, a delay in diagnosis can occur. We present the case of a healthy active duty soldier, with no previous medical history, found to have CD through an initial presentation of isolated umbilical drainage. Imaging workup identified an entero-uracho-cutaneous fistula with involvement of the transverse colon. Urachal anomalies are uncommon, and entero-urachal fistula as an initial presentation of CD is exceedingly rare. This case highlights the need to consider CD in the differential for patients with umbilical drainage despite a lack of concurrent more frequent presenting symptoms (abdominal pain, bloody diarrhea, and perianal fistula). Maintaining awareness of uncommon initial presentations of CD can minimize delay in diagnosis and thereby mitigate the risk of severe complications.
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Affiliation(s)
| | - Christina M Steinhauser
- Department of Gastroenterology, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Manish Singla
- Department of Gastroenterology, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Walter B Kucera
- Department of Surgery, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Gary G Wind
- Department of Surgery, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Surgery, 1685Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Thomas S Gerald
- Department of Urology, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Hernan O Altamar
- Department of Urology, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mary T O'Donnell
- Department of Surgery, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Surgery, 1685Uniformed Services University of Health Sciences, Bethesda, MD, USA
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Letzelter M, Andrianjafy C, Marin S, Rocour S, De Ybarlucea LR, Maillard H. [Metastatic Crohn's disease of the umbilicus: An exceptional location]. Rev Med Interne 2021; 43:54-56. [PMID: 34362570 DOI: 10.1016/j.revmed.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/23/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cutaneous manifestations of Crohn's disease are frequent and include metastatic lesions. These are separated from the digestive tract and affect particularly the limbs and major folds. Umbilical involvement is exceptional. CASE REPORT A 93-year-old woman followed for 6 years for Crohn's disease, in remission on infliximab, 5mg/kg every 8 weeks, consulted for a fissured and painful omphalitis. Histology revealed epithelioid granulomas without necrosis in the dermis, leading to the diagnosis of umbilical cutaneous metastasis of Crohn's disease. Infliximab intensification every 6 weeks led to a positive outcome. CONCLUSION We report a unique case of umbilical metastatic localization of Crohn's disease occurring during treatment with anti-TNF alpha. The diagnosis was based on skin biopsy and histology which found epithelioid granulomas without caseous necrosis.
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Affiliation(s)
- M Letzelter
- Service de dermatologie, Centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans.
| | - C Andrianjafy
- Service d'hépato-gastro-entérologie, Centre hospitalier le Mans, 194, avenue Rubillard, 72037 Le Mans
| | - S Marin
- Service d'hépato-gastro-entérologie, Centre hospitalier le Mans, 194, avenue Rubillard, 72037 Le Mans
| | - S Rocour
- Service d'anatomopathologie, Centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans
| | - L-R De Ybarlucea
- Service d'anatomopathologie, Centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans
| | - H Maillard
- Service de dermatologie, Centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans
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