Open AccessAn unusual presentation of fistulating Crohn’s disease: Ascites
Author(s) -
Richard Kia,
David C. White,
S Sarkar
Publication year - 2010
Publication title -
world journal of gastrointestinal endoscopy
Language(s) - English
Resource type - Journals
ISSN - 1948-5190
DOI - 10.4253/wjge.v2.i1.41
Subject(s) - medicine , ascites , hypoalbuminemia , gastroenterology , malignancy , colonoscopy , inflammatory bowel disease , crohn's disease , differential diagnosis , abdominal pain , disease , pathology , colorectal cancer , cancer
Whilst ascites is a common presenting complaint in patients with decompensated chronic liver disease and disseminated malignancy, in Crohn's disease however, it is exceptionally rare. We describe a patient with no prior history of inflammatory bowel or liver disease, presenting with rapid onset gross ascites and scrotal swelling. Further investigations revealed severe hypoalbuminemia and transudative ascitic fluid with normal other liver function tests and a negative liver screen. Computed tomography revealed widespread ascites and pleural effusions with no features of malignancy or portal hypertension, and a small bowel barium series showed features of fistulating small bowel Crohn's disease. An ileo-colonoscopy confirmed the presence of terminal ileal inflammatory stricture. The patient's clinical condition and serum albumin improved with a combination of diuretics, elemental diet, antibiotics and oral 5-aminosalicylic acid therapy.