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Doença de Crohn estenosante e o risco de cancro : revisão bibliográfica a partir de um caso clínico
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É comum nos pacientes com a Doença de Crohn (DC) o desenvolvimento de estenoses localizadas no íleon contendo diferentes graus de inflamação e fibrose. Alguns estudos já demonstraram que pacientes com DC têm um risco aumentado de desenvolvimento de adenocarcinoma do intestino delgado (AID) embora seja uma complicação rara. O diagnóstico de AID é um desafio presente na literatura médica porque a sua apresentação é altamente variável e semelhante a DC obstrutiva e ativa. Em muitos casos existe um atraso de diagnóstico e o tumor costuma ser detetado apenas na cirurgia num estadio avançado com mau prognóstico. Relata-se, nesta pesquisa, um caso de adenocarcinoma do íleon em um paciente idoso com Doença de Crohn estenosante ligeira do íleon mal vigiada, em tratamento com azatioprina, que após crise suboclusiva realiza cirurgia que revela uma neoplasia na peça operatória. O objetivo desta revisão narrativa é apresentar uma pesquisa atualizada sobre a Doença de Crohn estenosante e a sua relação com o risco de desenvolver adenocarcinoma do intestino delgado, com ênfase na gestão da doença em pacientes idosos. Por fim, a partir dos resultados obtidos espera-se abordar alternativas para o tratamento do paciente idoso com DC, bem como evidenciar a magnitude do risco da neoplasia nos pacientes com DC.
It is common in patients with Crohn's disease (CD) to develop localized strictures in the ileum containing varying degrees of inflammation and fibrosis. Some studies have shown that patients with CD have an increased risk of developing adenocarcinoma of the small bowel, although it is still a rare complication. The diagnosis of small bowel adenocarcinoma is a challenge present in the medical literature because its presentation is highly variable and similar to obstructive or active CD. This diagnosis may be delayed and frequently it is only detected in surgery at an advanced stage with poor prognosis. We report a case of adenocarcinoma of the ileum in an elderly patient with mild stricturing CD of the ileum, under azathioprine treatment, who, after a sub-occlusive crisis, underwent surgery, which showed a tumor on the surgical specimen. The objective of this narrative review is to present updated research on structuring Crohn’s Disease and its relation with the risk of developing adenocarcinoma of the small bowel, with emphasis on the management of the disease in elderly patients. Finally, from the results obtained it is expected to address alternatives for the treatment of the elderly patient with CD, as well as to highlight the magnitude of the risk of neoplasia in patients with Crohn’s Disease.
It is common in patients with Crohn's disease (CD) to develop localized strictures in the ileum containing varying degrees of inflammation and fibrosis. Some studies have shown that patients with CD have an increased risk of developing adenocarcinoma of the small bowel, although it is still a rare complication. The diagnosis of small bowel adenocarcinoma is a challenge present in the medical literature because its presentation is highly variable and similar to obstructive or active CD. This diagnosis may be delayed and frequently it is only detected in surgery at an advanced stage with poor prognosis. We report a case of adenocarcinoma of the ileum in an elderly patient with mild stricturing CD of the ileum, under azathioprine treatment, who, after a sub-occlusive crisis, underwent surgery, which showed a tumor on the surgical specimen. The objective of this narrative review is to present updated research on structuring Crohn’s Disease and its relation with the risk of developing adenocarcinoma of the small bowel, with emphasis on the management of the disease in elderly patients. Finally, from the results obtained it is expected to address alternatives for the treatment of the elderly patient with CD, as well as to highlight the magnitude of the risk of neoplasia in patients with Crohn’s Disease.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Doença de Crohn Adenocarcinoma do intestino delgado Idoso Estenose Gastroenterologia