Crohn’s disease in a developing African mission hospital

BACKGROUND: 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.

CASE
PRESENTATION: 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.

CONCLUSIONS: 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.

Keywords:
Crohn’s disease; Autoimmune disorder; Granulomatous colitis; Regional enteritis