Esophageal stricture as an initial manifestation of Crohn's disease

Abstract

A 51-year-old female was admitted to the hospital due to malnutrition secondary to logical and progressive dysphagia for five months. Upper endoscopy, esophagogram (Fig. 1), computed tomography of thorax, abdomen and pelvis (CT-TAP) (Fig. 2) and positron emission tomography (PET-CT) showed an esophageal stricture at 21 cm of the dental arcade, 8.4 cm long and with no evidence of malignancy in the histological and metabolic study. In addition, diffuse thickening of the proximal jejunal wall was observed, suggestive of Crohn's disease (CD).Conservative treatment was not effective and a transthoracic subtotal esophagectomy was performed. Pathologic analysis of the specimen revealed the presence of erosions and mucosal fissuring ulcers, with fibrosis and obliteration of the submucosal layer, accompanied by transmural inflammatory infiltrate (Fig. 3). All these findings were compatible with esophageal involvement by CD as the first diagnostic option.