P1667 - Unusual Presentation of Crohn's Disease as Pelvic Mass Involving the Genitourinary Organs and Bowels

Howard Chung, MD¹, Mahmoud Nassar, MD, PhD, MSc, MHA, MPA, CPHQ, SSBB², Dawa Gurung, MD², Beishi Zheng, MD³, Bing Chen, MD⁴, Saphwat Eskaros, MD⁵, Negar Niknam, MD^2
1Queens Hospital Center, Forest Hills, NY; ²Queens Hospital Center, Jamaica, NY; ³Woodhull Medical and Health Care Center, Brooklyn, NY; ⁴Mount Sinai Morningside and West Hospitals, New York, NY; ⁵Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, Queens, NY

Introduction: Crohn's disease (CD) is an inflammatory bowel disease which can cause both gastrointestinal and extraintestinal manifestations. Typical presentations are abdominal pain, diarrhea, and weight loss. We present a case of CD with atypical presentation and complications.

Case Description/Methods: A 49-year-old woman with no past medical and surgical history presented with abdominal pain and diarrhea. She was found to have a large pelvic mass with invasion to urinary bladder, right hydroureteronephrosis, and small bowel dilation on imaging. On cystoscopy, posterior bladder edema and mass effect was noted with a fistula draining success. Biopsy was performed with no evidence of cancer. During hospitalization patient developed high-grade small bowel obstruction. Therefore exploration laparotomy was performed with findings of a retroperitoneal mass extending to the bladder, uterus, recto-sigmoid, ureters, fallopian tubes, and distal ileum. The retroperitoneal mass, recto-sigmoid, distal ileum, and left fallopian tube, and ovary were removed. The patient then developed urinary tract infection associated with fecaluria, suggesting an enterovesicular fistula. The retroperitoneal mass pathology showed fibrous tissue with chronic inflammation. However, the resected ileum was reported a strictured lumen, ulceration, full-thickness inflammation with fibrous adhesion at the serosal surface suggestive of CD. Afterward, ASCA was checked and was positive.

Discussion: The common complications of CD include abscesses, bowel obstruction, perianal disease, fistulas, malnutrition, and cancer. However, unusual manifestations could remain undiagnosed if CD was not considered. Fecaluria and recurrent urinary tract infections are related to enterovesicular fistulas. Hydroureteronephrosis is caused by inflammatory penetration of the affected bowel and responds well to steroids. CD is known for fibrogenesis secondary to chronic inflammation, which was the etiology of our patient's large pelvic mass. CT and MRI remain the best modalities for retroperitoneal fibrosis detection. However, image studies cannot distinguish benign from malignant diseases. CD can have unexpected presentation and poor outcome, which could be prevented by high clinical suspicion, broad differential diagnosis, and early treatment which could lead to a favorable outcome.



Disclosures:


Howard Chung, MD¹, Mahmoud Nassar, MD, PhD, MSc, MHA, MPA, CPHQ, SSBB², Dawa Gurung, MD², Beishi Zheng, MD³, Bing Chen, MD⁴, Saphwat Eskaros, MD⁵, Negar Niknam, MD². P1667 - Unusual Presentation of Crohn's Disease as Pelvic Mass Involving the Genitourinary Organs and Bowels, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.