LONG ESOPHAGEAL STRICTURE IN CROHNS-DISEASE - A CASE-REPORT

Crohn's disease of the esophagus is rare, and it is very unusual for i t to be located only in the esophagus. We report a case of Crohn's dis ease confined to the esophagus in a 26-year-old female. The patient wa s admitted because of progressive dysphagia, odynophagia and weight lo ss. A barium-swallow examination showed an irregular narrowing of the esophagus below the level of the aortic arch which was 15cm long, with marginal ulcers and a pseudopolypoid appearance of the mucosa; a comp uted tomographic scan of the thorax revealed a thickened esophageal wa ll. Esophagoscopy revealed an esophageal stricture 25cm distal to the incisor teeth, 2mm in diameter, with ''punched out'' ulcers and pseudo polypoid mucosa. Endobiopsy specimens showed chronic lymphocytic infil tration into the corion in the absence of neutrophils, basal-cell hype rplasia and elongation of the stromal papillae.The patient underwent a n esophagectomy through a combined cervico-abdominal approach followed by a cervical esogastrostomy. The specimen was 18cm long, the thickne ss of the wall was 1.7cm with fibrosis involving all layers of the eso phageal wall and a cobblestone appearance of the mucosa. A heavy lymph oplasmocytic infiltrate extended from the mucosa deep into the muscula ris, fibrosis and granulomas were found transmurally. Crohn's disease of the esophagus is a rare and specific entity which can present in va rious ways; strictures resembling those from reflux esophagitis or a t umor are common. Diagnosis may be suggested by the presence of a chron ic lymphocytic infiltrate with or without non-caseating granulomas, an d no histologic evidence of chronic reflux esophagitis.