Adenocarcinoma complicating Crohn's disease of the duodenum

Duodenal obstruction is a classic complication of Crohn's disease with duod enal involvement. However, malignant transformation of duodenal lesions has very rarely been reported, and diagnosis of such a transformation is rarel y made preoperatively. We report the case of a 32-year-old patient with an 8-year history of Crohn's disease who underwent bypass gastrojejunostomy fo r a duodenal stricture. A year later, weight loss and biliary obstruction l ed to a further laparotomy. At operation, an advanced carcinoma with perito neal seedings was confirmed. Of the three patients previously reported in t he literature with duodenal cancer arising in Crohn's disease stricture, on ly one had a preoperative diagnosis of malignancy made from endoscopic biop sies. When considering the surgical bypass of Crohn's duodenal stricture, i f preoperative endoscopy and biopsy cannot be performed on account of duode nal stricturing, we suggest performing a peroperative endoscopy via a jejun otomy in order to eliminate the diagnosis of associated duodenal malignancy . Eur J Gastroenterol Hepatol 13:1259-1260( (C)) 2001 Lippincott Williams & Wilkins.