PHOTO QUIZ. Chronic abdominal pain and intestinal obstruction in a 24-year-old woman.

摘要

A 24-year-old woman from Saudi Arabia with type I diabetes mellitus presented to the emergency department with a 4-day history of severe abdominal pain, nausea, vomiting, abdominal distension, and constipation. She had been diagnosed with Crohn's disease 2 years earlier and was treated with azathio-prine, 5-aminosalicylic acid, and prednisone; she reported no improvement of abdominal symptoms despite treatment for 1 year. Her temperature was 37.1癈, heart rate was 104 bpm, and blood pressure was 103/67 mm Hg. Abdomen was distended, soft, and nontender, with exaggerated bowel sounds and no masses or organomegaly. Abdominal plain radiography revealed bowel distention with multiple air-fluid levels. Blood tests revealed a white blood cell count of 7.07 x 109cells/ L, with 70% neutrophils, 5% lymphocytes, 14.6% eosinophils, and 6% monocytes. The erythrocyte sedimentation rate was 94 mm/ hour. Liver enzymes including total bilirubin and alkaline phos-phatase were normal, as was renal function. Magnetic resonance imaging of the abdomen showed 2 long segments of circumferential heterogeneous enhancing soft tissue masses involving the descending colon and descending sigmoid colon with surrounding fat stranding and few nodular peritoneal deposits. There was bowel obstruction and multiple differentrsize hepatic lesions. Biopsy of the distal descending colon, proximal sigmoid, and recto-sigmoid showed focal active colitis with predominant eosinophils and ulceration with no evidence of malignancy.