They may further require medical attention and even emergency medical care in some critical cases.Ībdominal pain is the primary symptom of these 9 diseases: There are some serious conditions that cause abdominal pain which should not be ignored. The most common symptom that indicates the presence of abdominal abnormalities is “abdominal pain” which can be described in different types such as cramp, ache, dull pain, intermittent pain and sharp pain. If any particular part of these organs is damaged or impaired, warning signs and symptoms will be manifested accordingly. Other important internal organs located in abdominal cavity include liver, gallbladder, bile duct and pancreas. Our digestive system begins at the mouth, pharynx and esophagus, stomach, small intestine, large intestine (also known as the colon) and rectum. J Crohns Colitis 2013 7:982-1018.Digestive system is uniquely constructed to perform its specialized functions including ingestion, mechanical and chemical digestion, absorption and excretion (or defecation). European Crohns and Colitis Organization (ECCO) evidence based consensus for endoscopy in inflammatory bowel disease. European Society of Gastrointestinal Endoscopy (ESGE) Guidelines: Flexible enteroscopy for diagnosis and treatment of small-bowel diseases. IBD across the age spectrum-is it the same disease? Nat Rev Gastroenterol Hepatol 2014 11:88-98. Crohn's disease initially diagnosed after age 60 years. Inflammatory bowel disease in the elderly. Current guidelines recommend that in the suspicion of stricturing CD, direct visualization by balloon-assisted enteroscopy allows discrimination of active inflammation within the stenotic segment, and is the method of choice to obtain endoscopic and histological confirmation (4,5).ġ. In this case, assessment of small-bowel with SBE was crucial. Although CD has a bimodal distribution in incidence, very few are diagnosed beyond the eighth decade (3). Crohn's own experience, only 7 out of 530 patients were diagnosed after age 60 years (2). Prior studies describing elderly-onset CD are limited to small number of patients. She was started on immunosuppressive therapy with azathioprine.ĭiagnosis of inflammatory bowel disease in this age group is difficult because it can be easily confused with other diseases, including infections, ischemia, vasculitis, cancer and drug-associated enteritis, particularly NSAIDs (1). The patient recovered uneventfully with conservative management. The diagnosis of stricturing small-bowel Crohn's disease (CD) was established by clinical evaluation and a combination of endoscopic, histological, radiological and biochemical investigations (A3L1B2, Montréal classification). 5) acid-fast bacilli smear and culture were negative. Biopsies revealed irregular villous architecture, discontinuous inflammation and focal crypt irregularity ( Fig. 4) were observed the interposed mucosa was intact. Several ulcerated luminal strictures ( Fig. We proceeded to perform an anterograde single-balloon enteroscopy (SBE). Serum and faecal microbiological assays were negative. Subsequent computed tomography scan revealed several small-bowel stenotic segments, with concentric wall thickening, intense mucosal enhancement, and pre-stenotic dilatation ( Fig. Abdominal X-ray displayed multiple air-fluid levels in the small intestine ( Fig. Laboratory investigation disclosed iron-deficiency anaemia (haemoglobin 10.2 g/dl), leucocytosis (17,000/µL) and elevated C-reactive protein (6.51 mg/dL, normal range < 0.5 mg/dL). Physical examination revealed diffuse abdominal tenderness and hyperactive bowel sounds, without peritoneal signs. Of note, she denied non-steroid anti-inflammatory drugs (NSAIDs) consumption. Her past medical history was mostly unremarkable. She reported three months of nausea, abdominal pain and distension, without fever, hematoquezia or weight loss. Gaia, PortugalĪn 82-year-old woman was admitted with 24-hour colicky abdominal pain and vomiting. Teresa Pinto-Pais, Rolando Pinho, Adélia Rodrigues and João Carvalhoĭepartment of Gastroenterology and Hepatology. An elderly woman with obstructive symptoms: A surprising diagnosis
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