Retrograde enteroclysis by doubleballoon enteroscopy in a patient withblunt abdominal trauma: small bowelstricture, intraluminal vascular lesionand Crohn’s disease

摘要

A 40-year-old male presented to the Emergency Department after a driving accident with blunt abdominal trauma. An abdominal computed tomography (CT) scan revealed a mesenteric injury in the right lower quadrant. He was admitted two months later due to a one-day history of abdominal pain and diarrhea, without fever or blood. The CT angiography showed a pseudoaneurysm located in the proximal ileum and several rigid small bowel (SB) loops with segmental wall thickening of mucosa (Fig. 1A). An anal double-balloon enteroscopy (DBE) (3.2 mm large channel) was performed and revealed a severe ulcerated stricture (Fig. 1B), approximately 40 cm of ileocecal valve. The area was biopsied and tattooed. The endoscope could not pass beyond that point, so hydrosoluble contrast media and carbon dioxide were instilled via enteroscopy (retrograde enteroclysis) (Fig. 1C). A 5 cm stenotic ileum loop and a proximal mobile intraluminal lesion congruent with a pedunculated polyp was identified. The histopathology report of the SB biopsies showed non-specific ileitis without granulomas. The patient underwent a laparoscopic resection of the ileal segment with a primary anastomosis. The histopathological diagnosis was pedunculated cavernous hemangioma and Crohn’s disease (CD).