SMALL BOWEL ADENOCARCINOMA ARISING IN LONGSTANDING FIBROSTENOTIC CROHN’S DISEASE
Empirical evidence suggesting a link between neoplasia and chronic inflammation was first noted by Virchow more than a century ago, but the intricacies of the involved pathological processes have not yet been entirely elucidated. With a growing number of Crohn’s disease (CD) cases worldwide, it is only logical to consider that the complications of this entity would become proportionally more prevalent. We report a case of small bowel adenocarcinoma arising in a patient with longstanding CD and discuss the current differences in paradigms related to surgical decisions in patients with inflammatory small bowel disease. A 56-years-old male patient known with CD was admitted in emergency to our clinic for intense diffuse abdominal pain spontaneously and on palpation, Blumberg +, with signs of peritoneal irritation, episode apparently much more severe compared to the previous ones. Laboratory investigations confirmed the diagnosis of acute abdomen and immediate surgery was performed. Intraoperative findings were peritonitis due to ileal perforation and ileal adenocarcinoma with “signet ring” cells, moderately differentiated (G2), on the background of active inflammatory bowel disease (CD). Segmental enterectomy and ileostomy were performed. The postoperative outcome was relatively favorable, with resumption of digestive tolerance and of intestinal transit at ileostomy level. As increased evidence suggest causality between chronic inflammation and malignant transformation one should contemplate whether the old treatment paradigms applied for other conditions such as fistulae in anal and leg ulcers should not be translated to inflammatory bowel disease (IBD) patients. Are we doing too much or not enough surgery for IBD? Could we diagnose small bowel adenocarcinomas in CD in early stages or there is too much risk for the patients and very few to benefit from a more aggressive surveillance?
2. Spataru RI, Martius E, Ivan LE, Sîrbu D, Hostiuc S. Pseudomembranous colitis complicating the natural course of Crohn’s disease in a pediatric patient. Romanian Journal of Legal Medicine 2014: 22(3): 161-166.
3. Gilca-Blanariu GE, Stefanescu G, Afrasanie VA, et al. Evaluating predictive factors for disease activity among patients with inflammatory bowel disease. Rev Med Chir Soc Med Nat Iasi 2020; 124(3): 367-373.
4. Muzica CM, Stanciu C, Huiban L, et al. Colonic tuberculosis versus Chron’s disease. Case report and review of the literature. Rev Med Chir Soc Med Nat Iasi 2020; 124(3), 394-399.
5. Serban D, Spataru RI, Vancea G, et al. Informed consent in all surgical specialties: from legal obligation to patient satisfaction. Rom J Leg Med 2020; 28(3): 317-321.
6. Socea B, Dumitrescu D, Bratu OG, et al. Inflammatory bowel diseases: the surgical perspective. Modern Medicine 2019: 26(1): 13-16.
7. Ginzburg L, Schneider KM, Dreizin DH, Levinson C. Carcinoma of the jejunum occurring in a case of regional enteritis. Surgery 1956; 39: 347-351.
8. Ammann R, Bivetti J, Kobler E, Peter P. Gastroenterologic roentgen quiz. Leber Magen Darm 1977; 7: 91-130.
9. von Roon AC, Reese G, Teare J, Constantinides V, Darzi AW, Tekkis PP. The risk of cancer in pa-tients with Crohn’s disease. Dis Colon Rectum 2007; 50: 839-855.
10. Mpofu C, Watson AJM, Rhodes JM. Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease. Cochrane Database of Systematic Reviews 2004; 2: CD000279 / doi: 10.1002/14651858.CD000279.pub2.
11. Brănescu C, Serban D, Dascălu AM, Oprescu SM, Savlovschi C. Interleukin 6 and lipopolysaccharide binding protein - markers of inflammation in acute appendicitis. Chirurgia (Bucur) 2013; 108(2): 206-214.
12. Sanchez-Munoz F, Dominguez-Lopez A, Yamamoto-Furusho JK. Role of cytokines in inflammatory bowel disease. World J Gastroenterol 2008; 14(27): 4280-4288 / doi:10.3748/wjg.14.4280
13. Serban D, Smarandache AM, Cristian D, et al. Medical errors and patient safety culture - shifting the healthcare paradigm in Romanian hospitals. Rom J Leg Med 2020; 28(2): 195-201.
14. Savlovschi C, Brănescu C, Serban D, et al. Amyand’s hernia - a clinical case. Chirurgia (Bucur). 2010; 105(3): 409-414.
15. Birindelli A, Tugnoli G, Beghelli D, et al. Emergency laparoscopic ileo-colic resection and primary intracorporeal anastomosis for Crohn’s acute ileitis with free perforation and fecal peritonitis: first ever reported laparoscopic treatment. Springerplus 2016; 5: 16 / doi:10.1186/s40064-015-1619-x
16. Serban D, Smarandache CG, Tudor C, et al. Laparoscopic Surgery in COVID-19 Era-Safety and Ethical Issues. Diagnostics (Basel) 2020; 10(9): E673 / doi: 10.3390/diagnostics10090673.
17. Fontana T, Falco N, Torchia M, Tutino R, Gulotta G. Bowel perforation in Crohn’s Disease: correlation between CDAI and Clavien - Dindo scores. G Chir 2017; 38(6): 303-312 / doi:10.11138/gchir/ 2017.38.6.303
18. Leal RF, Ward M, Ayrizono Setsuko M de L, et al. Free peritoneal perforation in a patient with Crohn’s disease - Report of a case. Int J Surg Case Rep 2013; 4(3): 322-324.
19. Eid HO, Hefny AF, Joshi S, Abu-Zidan FM. Non-traumatic perforation of the small bowel. African Health Sciences 2008; 8(1): 36-39.
20. Spataru R. The use of mechanical suture in the treatment of Hirschsprung’s disease: experience of 17 cases. Chirurgia (Bucur) 2014; 109(2): 208-212.
21. Alius C, Tudor C, Badiu CD, et al. Indocyanine Green-Enhanced Colorectal Surgery-between Being Superfluous and Being a Game-Changer. Diagnostics (Basel) 2020; 10(10): E742 / doi: 10.3390/diagnostics10100742.
22. Olén O, Erichsen R, Sachs MC, et al. Colorectal cancer in Crohn’s disease: a Scandinavian population-based cohort study. The Lancet Gastroenterology & Hepatology 2020; 5(5): 475-484.
23. Strong S, Steele SR, Boutrous M, et al. Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. Clinical Practice Guideline for the Surgical Management of Crohn’s Disease. Dis Colon Rectum 2015; 58: 1021-1036.
24. Kiran RP, Nisar PJ, Goldblum JR, et al. Dysplasia associated with Crohn’s colitis: segmental colec-tomy or more extended resection? Ann Surg 2012; 256: 221-226.
25. Laukoetter MG, Mennigen R, Hannig CM, et al. Intestinal cancer risk in Crohn’s disease: a meta-analysis. J Gastrointest Surg 2011; 15: 576-583.
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
N.B. All the authors must sign this form