Isolated Esophageal Crohn’s Disease with Diffuse Stricture

Abstract
Background: Esophageal strictures are considered to be one of the most challenging matters for gastroenterologist, general and thoracic surgeons in diagnosis and management. They can be grouped into three general categories: intrinsic diseases, extrinsic diseases, and diseases that disrupt esophageal peristalsis and/or lower esophageal sphincter (LES) function. Crohn’s disease (CD) is a very rare cause of esophageal stricture. The prevalence of esophageal CD ranges from 1% to 2% in adults with CD. It is almost diagnosed lately when complications have occurred as Strictures, fissures, esophagobronchial fistulas, and mediastinal abscesses. Case Report: Thirty-nine years old Kurdish patient, referred to our department for evaluation. Although many consultations during the last two years, the Pt was still undiagnosed. She had progressive dysphagia, and weight loss of about 25 kg. She had no other digestive or extra digestive complaint, nor caustic ingestion history and nor drug history. Chest CT scan and UGI Contrast study revealed diffuse smooth and regular esophageal stenosis. Attempts to do upper endoscopy and biopsy failed due to severe stenosis. Prolonged medical history and radiologic signs exclude malignancy, so esophagectomy with stomach pull-through was done by the aid of VATS and laparoscopy with excellent results. Pathological finding of the resected esophagus suggested the diagnosis of Crohn’s disease CD. Conclusions: CD is a rare cause of esophageal stricture and still to be a challenging early diagnosis due to the low specificity of clinical manifestations (aphthous ulcers), histologic findings (absence of granulomas), and endoscopic findings. So many patients have been diagnosed with complications (esophageal strictures, fistulas) which needed surgical treatment, adding greater morbidity and mortality. MIS (thoracoscopy-laparoscopy) is valuable in decreasing the morbidity and mortality and improving the quality of life for those patients.