SMALL INTESTINAL BIOPSY IN A PATIENT WITH CROHNS-DISEASE OF THE DUODENUM - SPECTRUM OF ABNORMAL FINDINGS IN THE ABSENCE OF GRANULOMAS

  • 1 January 1979
    • journal article
    • research article
    • Vol. 76  (5) , 1009-1014
Abstract
The case of a patient who presented with an occult anemia that was due to Crohn''s disease of the duodenum is reported. The initial evaluation revealed low serum levels of Fe, folate, and carotene, and a small bowel series was abnormal but not diagnostic of Crohn''s disease. Numerous small intestinal biopsy specimens were obtained from the duodenum and proximal jejunum in an unsuccessful attempt to make a diagnosis. Radiography and laparotomy showed 2 yr later that the patient had Crohn''s disease of the proxiaml small intestine. A detailed analysis of the spectrum of abnormalities found by peroral mucosal biopsy in this patient is provided. These abnormalities were patchy and included flattened mucosa, an abnormal surface epithelium which was infiltrated by large numbers of polymorphonuclear leukocytes, increased plasma cells and polymorphonuclear leukocytes within the lamina propria, crypt abscesses, erosions, granulation tissue, and pyloric gland metaplasia, all in the absence of granulomas. Crohn''s disease should always be considered in the differential diagnosis of a proximal small bowel mucosal disease, especially when a constellation of acute inflammatory changes is present.

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