Gastric Crohn’s disease presenting as a subepithelial tumor: A case report

Abstract

BACKGROUND

Submucosal tumors arise from the subepithelial layer anywhere along the gastrointestinal tract, most commonly in the stomach. A wide range of lesions, from benign to malignant, may present as gastric submucosal tumors. However, the gastric involvement of Crohn’s disease (CD) is generally not considered in the differential diagnosis of such lesions.

CASE SUMMARY

A 23-year-old male patient presented with a gastric subepithelial tumor. The medical history included CD. Diagnostic workup revealed a 3-cm mucosal lesion with a central ulceration on the posterior wall of the distal antrum. The patient underwent laparoscopic wedge resection of stomach, and the postoperative course was uneventful. Histopathological analysis confirmed a diagnosis of gastric CD presenting as a subepithelial tumor.

CONCLUSION

Despite its rarity, upper gastrointestinal CD can present as a gastric subepithelial tumor, warranting consideration in young patients with CD.

Keywords: Crohn’s disease; Gastric involvement; Subepithelial tumor; Differential diagnosis; Endoscopic ultrasonography; Case report

Core Tip: Given the increasing incidence of Crohn’s disease (CD) and its decreasing age of onset, upper gastrointestinal involvement is expected to become more frequent. Although gastric CD typically presents as gastritis, erosions, atypical ulcers, a cobblestone appearance of the mucosa, or strictures, it can (albeit rarely) manifest as a subepithelial tumor, as demonstrated in this case. Therefore, when a gastric subepithelial lesion is detected-particularly in young patients with CD-endoscopic ultrasonography and histological assessment are essential to distinguish upper gastrointestinal involvement of CD from other etiologies.