Crohn’s disease in a developing African mission hospital

<br><b>BACKGROUND:</b> We report a case of innocuous intestinal obstruction requiring surgical intervention which was confirmed to be Crohn’s disease histopathologically in a resource-constrained rural mission hospital in the Cameroon. <b>CASE PRESENTATION:</b> The clinical presentations of a 70-year male of Kumbo origin from Northwestern region of Cameroon with a history of crampy right lower quadrant abdominal pain, non-bloody, non-mucoid diarrhea alternating with constipation. Abdominal examination revealed an ill-defined mass in the right iliac fossa and visible peristalsis. Abdominal CT scan and Barium enema study confirmed a complex ascending colonic and caecal tumor. He had exploratory laparotomy and intraoperative finding was a huge complex inflammatory mass involving the caecum, terminal ileum and the sigmoid colon. He subsequently had sigmoidectomy with end to end sigmoido-rectal anastomosis, a caecal resection and the proximal ascending colon exteriorized as end mucoid fistula and terminal ileostomy were performed. The histopathological diagnosis confirmed Crohn’s disease. He subsequently had adjuvant chemotherapy consisting of Azathioprine, Methotrexate, Mesalamine and Methyl-prednisolone. The patient had complete disease remission and presently on maintenance dose of mesalamine and omeprazole treatment. He has been followed- up two monthly in the surgical outpatient clinic over the last 16months with satisfactory clinical outcome. <b>CONCLUSIONS:</b> Crohn’s disease is uncommon in Africa yet we come across this entity sparingly. The signs and symptoms of Crohn’s disease overlap with many other abdominal disorders like tuberculosis, ulcerative colitis, irritable bowel syndrome etc. Several literature submit that it is difficult to make an accurate diagnosis of this disease, despite the fact that many diagnostic armamentaria are available to suggest its presence. Most of the patients with Crohn’s disease are treated conservatively and a few may require surgical intervention especially presenting with complications like intestinal obstruction, perforations, and abscess as well as fistula formations as seen in this index patient. Crohn’s disease is considered by many as a very rare disease in Africa. It is interesting to know that Crohn’s disease which affects mainly young adults may debut at any age. Rarity and clinical curiosity of this entity suggest reporting of this case. The author also documented an evidence-based up-to-date information on Crohn’s disease. <br><b>Keywords: Crohn’s disease; Autoimmune disorder; Granulomatous colitis; Regional enteritis</b>