A 75-year-old woman with multifocal jejunal strictures

Clinical presentation A previously fit and well 75-year-old Caucasian woman presented with a 2-month history of postprandial abdominal pain, vomiting and 10 kg weight loss without diarrhoea. Blood investigations showed marked hypoalbuminaemia of 18 g/L and elevated C reactive protein (CRP) of 185 mg/L. Tissue transglutaminase IgA level was within normal limits without evidence of IgA deficiency. Faecal calprotectin was elevated at 205 µg/g. Abdominal CT revealed subacute small bowel obstruction characterised by multiple long, thick walled, dilated loops of jejunum (figure 1) associated with lymphadenopathy. Histological findings from laparoscopic mesenteric lymph node resection showed reactive features only. Intravenous hydrocortisone was started with subsequent symptomatic improvement in tolerated oral intake, paralleled by a reduction in CRP to 25 mg/L. Antegrade double balloon enteroscopy (DBE) was performed to directly visualise the small bowel mucosa (figure 2). Question What is the diagnosis? See page 1982 for answer

Source: Gut - October 31, 2014 Category: Gastroenterology Authors: Lee, H. Y., Howarth, G., Willert, R. Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research