Crohn's disease unusual form of presentation and diagnosis.

Abstract

Inflammatory Bowel Disease (IBD) is characterized by chronic inflammation of the intestinal mucosa, where patients go through periods of remission and relapse. Within the spectrum of the disease we find its variants ulcerative colitis (UC), Crohn's disease (CD), indeterminate colitis (IC) or unclassified IBD (IBD nC). This set of entities has a multifactorial etiology,  it may be due to genetic factors, but recently an increase in its diagnosis has been observed and it is related to environmental factors such as diet and intestinal dysbiosis.

The incidence in developed countries is approximately 10 per 100,000 children, with 20% in children under 10 years of age. There are few data on its incidence in Latin America. Approximately 25% of cases are diagnosed in childhood and adolescence.

The clinical manifestations of IBD will depend on the location and the time of evolution of the disease, it can manifest with extra-intestinal symptoms, which can delay the diagnosis.

Endoscopy with biopsy is the main diagnostic tool; however, other imaging studies, especially magnetic resonance enterography, must be available to assess the extent of the disease. In recent years there has been access to capsule endoscopy that will help determine lesions in areas where endoscopy cannot be reached.

A case of interest is presented that debuts as occult bleeding with inconclusive upper and lower digestive endoscopy up to the terminal ileum and through capsule endoscopy the diagnosis of Crohn's disease of the jejunum could be established.