Coincidence of Crohn's disease and a high-risk gastrointestinal stromal tumor of the terminal ileum

A 51-year-old male patient presented with characteristic radiologic feature s of Crohn's disease in the terminal ileum plus a large tumorous lesion in the right lower abdomen. Because of rapid crescent symptoms of bowel obstru ction, the patient underwent surgery revealing a high-risk gastrointestinal stromal tumor (GIST) of the terminal ileum within an area of Crohn's ileit is. Whereas the association of chronic inflammatory bowel disease (IBD) and gastrointestinal adenocarcinoma is well known, other primary intestinal tu mors are rare in these patients, particularly at the time of onset of clini cal symptoms. This is the 3rd patient reported in the literature with a sar coma complicating IBD, and in fact, the first description of the coincidenc e of Crohn's disease and GIST. Though the present case is likely to be a me re coincidence of two pathologically distinct entities (without any potenti al causal relationship), it should remind one of the possibility of small b owel 'Crohn's carcinoma' in patients with a sudden change in symptomatology as well as in those in whom intestinal obstruction fails to resolve with a dequate therapy.