Gastric outlet obstruction and pulmonary infiltrate in a patient with Crohn's disease: Successful treatment by Billroth-II-resection

We present a 28-year-old women with a 3 yr history of duodenal ulcers, Foll owing four treatment attempts to eradicate helicobacter pylori she was admi tted because of gastric outlet obstruction and a weight loss of 20 kg withi n the last two years. Endoscopy and x-ray showed a circular inflammatory st enosis of the proximal duodenum extending over 8 cm. Additionally, chest x- ray showed a circumscript infiltrate in the third segment of the rig ht lun g. Mycobacterial infection could be excluded. Ileocolonoscopy and small int estinal follow-through beyond the duodenum were unremarkable, and Zollinger -Ellison-syndrome was ruled out. Bronchopulmonary histology showed intramuc osal epitheloid-cell granulomas and bronchiolitis obliterans. Because the p atient did not improve under conservative therapy a Billroth-II-resection w as carried out. Histologically the resected specimen showed Crohn-like lesi ons. Postoperatively, severe peripheral arthritis was treated by steroids o ver 6 weeks. At follow-up the patient regained 20 kg and was free of sympto ms without any medication. The pulmonary infiltrate had subsided almost com pletely. In summary, this extremely rare coincidence of isolated stenosing duodenal Crohn's disease and pulmonary involvement was successfully treated by Billroth-II-resection. This course of disease is compatible with the hy pothesis that Crohn's disease may be maintained by antigens derived from in gested food.