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Abstract
Objective: To report
a case of Crohn’s disease
that presented with a clinical
picture mimicking a strangulated
incisional hernia.
Case Report: A 33-year-old
Saudi male patient presented
to the Emergency Department
(ED) with vomiting, pain,
and swelling at the right
iliac fossa after lifting
heavyweight objects two days
earlier. The patient had a
past history of appendectomy
through a transverse incision
nine years earlier. Clinically,
the patient was vitally stable.
He had tenderness at the right
iliac fossa, and rebound tenderness.
A tender swelling (6 x 8 cm)
was observed underneath the
previous scar. It was firm,
not expansile on cough, and
not reducible, with no redness
or skin changes. The laboratory
report showed normal results
for complete blood count,
apart from slight leukocytosis.
Blood electrolyte levels,
renal and liver function tests
were normal. Plain CT abdomen
showed a defect in the transversus
abdominis muscle with the
presence of swelling beneath
the oblique muscles associated
with air, which were connected
to the bowel. The preliminary
diagnosis was a “strangulated
incisional hernia”. After
laparotomy, the swelling showed
pus within the external oblique
aponeurosis, with a fistula
tract connected to the ileum.
After abdominal exploration,
the inflammation was observed
to be limited to the ileum
and cecum with no other abnormality
noted. Ileocecectomy was done
with side-to-side anastomosis
between the ileum and ascending
colon. The resected part was
sent for histopathology, which
confirmed the characteristics
of Crohn’s disease.
Conclusions:
The diagnosis of Crohn’s
disease remains challenging.
Its management is multi-disciplinary.
Surgical management is dependent
on disease location and severity.
It seems that early surgery
is gradually going to play
a more important role in the
multidisciplinary management
of Crohn’s disease, rather
than being a last-resort therapy.
Key
Words: Crohn’s disease,
Diagnosis, Surgical management,
Case Report.
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