Crohn's disease presenting as pyloric stenosis.

An upper gastrointestinal endoscopy was performed on a 78 year-old woman affected of bloating and mild anemia. Her medical history included high blood pressure, diabetes mellitus and hypercholesterolemia. She had been performed a cholecystectomy and hysterectomy several years before. Apart from a mild hypochromic anemia she was on a good health, her physical exploration didn’t revealed any pathological signs and the rest of the blood analysis only disclosed low iron levels. Gastroscopy showed a normal stomach with no food residue in it. The antrum was retracted and an ulcerated and stenotic pylorus was seen (Figs. 1 and 2) which could be passed through, showing a normal duodenum. On taking biopsies it was hard on touch and moved as a whole but the histological study only disclosed scar tissue without malignancy. The patient was put on high dose of proton pump inhibitors and scheduled for a new endoscopy in 4 weeks. The second endoscopy revealed the same picture but this time it was impossible to get through the pylorus and reach the duodenum; biopsies again did not help us. A CT scan showed gastric food retention and thickening of antrum and pylorus without pathological lymph nodes. Due to the lack of improvement she was sent to surgery. On the operation an inflammatory pyloric mass was detected with several lymph nodes surrounding. A partial distal gastrectomy with jejunal anastomosis was performed. The histology study showed an acute and chronic inflammatory of the pylorus with small aphtoid ulcers and non-caseating granulomas (Fig. 3). The patient did well after surgery and was discharged and controlled as an outpatient. Crohn’s disease presenting as pyloric stenosis