• Abdominal pain and palpable mass
• Low-grade fever, lassitude, weight loss
• Radiographic findings of thickened, stenotic bowel with ulceration and internal fistulas
• A chronic progressive granulomatous inflammatory disorder affecting any part of the GI tract
• From 2 to 9 cases per 100,000 are detected annually in the United States
• Geographic variation (more common in urban dwellers and Northern residents of the United States), and there is a relatively high incidence among Ashkenazi Jews
• Peak incidence between the second and fourth decades
• The cause is unknown; appears to result from the interaction of genetic and environmental factors.
• The distal ileum is the most frequent site of involvement, eventually becoming diseased in 75% of cases
• Small bowel alone is involved in 15-30%, both the distal ileum and the colon in 40-60%, duodenum in 0.5-7%.
• Diarrhea: Characteristically contains no blood if small bowel alone is diseased
• Acute and recurrent abdominal pain
• Weight loss
• Palpable abdominal mass
• Abdominal tenderness
• Anorectal lesions: Chronic anal fissures, large ulcers, complex anal fistulas, or pararectal abscesses
• Iron deficiency or macrocytic anemia due to vitamin B12
or folate deficiency
• Elevated ESR
• Abnormal d-xylose absorption suggests extensive disease or fistula formation, since carbohydrate is normally absorbed in the jejunum.
• Systemic manifestations include:
• About 70% of patients with Crohn disease undergo a definitive operation
• If multiple strictures are encountered, they can be treated by "strictureplasty," in which the bowel is incised through the stricture and the wall is sutured or stapled so that the lumen is widened.
• Acute exacerbations
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