Evaluating Ileal and Colonic Strictures: Crohn’s Disease or Metastatic Cancer?

Overview

A 62-year-old woman with multiple ileal and colonic strictures initially suspected as Crohn’s disease was ultimately diagnosed with metastatic breast lobular adenocarcinoma after surgery. This case underscores the importance of considering metastatic malignancies in the differential diagnosis of gastrointestinal strictures when inflammatory markers and biopsies are inconclusive.

Background

Crohn’s disease (CD) is a chronic inflammatory bowel disease often complicated by intestinal strictures. However, several other conditions, including infections, infiltrative diseases, and malignancies such as metastatic tumors, can mimic CD clinically and radiologically. Metastases to the gastrointestinal tract, though rare, may present with symptoms and imaging findings similar to CD, complicating diagnosis. Accurate differentiation is critical as treatment and prognosis differ substantially between CD and metastatic disease.

Data Highlights

Key Findings

• Multiple ileal and colonic strictures with imaging findings suggestive of Crohn’s disease were identified.
• Endoscopic biopsies showed nonspecific inflammation without dysplasia, failing to confirm Crohn’s disease.
• Biochemical markers (mildly elevated CRP and fecal calprotectin) were inconsistent with severe inflammatory bowel disease.
• Surgical specimens revealed metastatic breast lobular adenocarcinoma infiltrating intestinal layers.
• Subsequent breast imaging confirmed a primary breast tumor, and systemic therapy was initiated with stable disease at one-year follow-up.

Clinical Implications

Clinicians should maintain a broad differential diagnosis when evaluating intestinal strictures, especially when inflammatory markers and biopsies do not conclusively support Crohn’s disease. Metastatic malignancies, including breast cancer, can mimic inflammatory bowel disease and require distinct management strategies. Comprehensive diagnostic evaluation integrating clinical, biochemical, endoscopic, histological, and imaging data is essential to avoid misdiagnosis and guide appropriate treatment.

Conclusion

This case highlights the critical need to consider metastatic cancer in patients presenting with multiple gastrointestinal strictures and inconclusive inflammatory markers. A multidisciplinary approach is vital to ensure accurate diagnosis and optimal patient outcomes.

References

1. ECCO Guidelines 2022 -- Diagnosis and Management of Crohn’s Disease
2. Metastatic GI Tumors Review 2020 -- Clinical and Radiological Features
3. Case Report 2023 -- Breast Cancer Metastasis Mimicking Crohn’s Disease