Laparoscopy to correctly diagnose and treat Crohn's disease of the ileum

A 27-year-old woman with a past history of pulmonary tuberculosis presented with right iliac fossa pain and low-grade fever. She was empirically treated for Crohn's disease despite undergoing multiple investigations that failed to provide a strongly suspected diagnosis. After 3 days of therapy, her symptomatology aggravated, and signs suggestive of intestinal obstruction developed. Placing the patient in the left lateral decubitus position before sterile draping, intracorporeal laparoscopy was performed, and Crohn's disease involving the terminal ileum but sparing its most distal 25 cm was confirmed. During the procedure, creeping mesenteric fat, a characteristic feature of Crohn's disease, was seen. Also, some adhesions in the right iliac fossa and a firm 3-cm inflammatory mass were found. Both division of mesentery along with terminal ileum resection and ileocolonic anastomosis were successfully performed intracorporeally, without need to convert to open surgery. In select cases of right iliac fossa pain in which diagnostic and therapeutic results are inconclusive or equivocal, laparoscopy can be useful to correctly diagnose and treat inflammatory bowel disorders such as Crohn's disease. Moreover, we suggest that intracorporeal laparoscopic surgery can be effective in the treatment of these conditions even in some cases with intestinal complications such as inflammatory masses and adhesions.