NEOPLASTIC IMITATORS OF SMALL-BOWEL CROHNS-DISEASE

OBJECTIVE: To identify the problem of small bowel neoplasia masquerading as Crohn's disease. DATA AND METHODS: Sixteen articles reviewing the frequency of small bowel neoplasia were identified. Articles were selected if they assessed frequency of small bowel tumours in the general population. All articles were retrospective reviews of experience. Data on frequency were extracted and compiled. Three case reports as illustrative examples and a Medline search of small bowel neoplasms with manual searching of references from identified articles are presented. RESULTS: A total of 2507 cases of small bowel tumours was compiled. The frequency of tumours in decreasing order was adenocarcinoma, carcinoid, lymphoma, leiomyoma, leiomyosarcoma, adenoma and lipoma. CONCLUSIONS: Crohn's disease is the most prevalent disease affecting terminal ileum. Malignant disease may affect the terminal small bowel in ways which are clinically indistinguishable from Crohn's disease. Surgery is the last therapeutic option for Crohn's disease, whereas it is potentially curative and therefore the first option for small bowel neoplasia. Misdiagnosing malignant processes as being Crohn's disease causes delays in effective treatment and worsens prognosis.