Crohn's disease as a differential diagnostic problem in the elderly (case reports)

Despite the fact, that Crohn's disease appear most frequently in the first three decades of life, and the proportion of ulcerative colitis increases among inflammatory bowel disease patients by the time, approximately 15% of Crohn's disease cases are recognized only after the age of 65.

First we present the case of a 70-years-old woman, who was admitted to our ward because of abdominal cramps and nausea. Before admission ultrasound imaging was performed in a county hospital, which revealed the possibility of inflammation of the terminal ileum. Colonoscopy did not prove any pathologic lesion, but reached only the ascending colon. 5-ASA and steroid therapy was not effective. After admission to our hospital the repeated colonoscopy (reaching the terminal ileum), and radiographic imaging of the small intestines proved the inflammation of the terminal ileum causing obstruction of the bowel. Explorative laparotomy was performed and beside a conglomerate containing the cecum, some loops of the small intestines and the ascending colon, a periappendicular abscess was discovered and resected. Histologic evaluation made Crohn's disease probable as the cause of the condition, but ischemic enteritis could not been excluded either.

The second case was an 81 years-old woman, with a history of expolaritve laparotomy, when she was 21 years old, because of ileus. She had persistent bloating during her life. In 2002 radiographic imaging of the small bowels and irrigoscopy were performed, but did not reveal any pathologic findings. The patient was admitted to our institute in the summer of 2005., because of abdominal cramps, provoked by meals, and weight loss. This time radiographic imaging of the small intestines showed a 20cm long obstruction of the terminal ileum, with pseudopolyp formation. After exploration the histology of the resected bowel segment proved Crohn's disease.

These cases focus on the possibility and diagnostic difficulties of Crohn's disease in the elderly and also the importance of the development of long term treatment strategies. Making an unambiguous diagnosis can be difficult, like in our first case, and one has to consider other differential diagnostic problems as in young Crohn's disease patients.