A “Shamrock” Deformity Due to Crohn’s Disease

Abstract

The patient was referred for possible surgical treatment in August 1988 with a 12-year history of Crohn’s disease. He had been unwell for 12 months, with an increase in chronic diarrhea, particularly at night (×5). A barium enema showed a “disorganized” colon with shortening, sacculation, and strictures. A colonoscopy was possible only to 30cm (stricture). An anal stricture was present, the mucosa in the mid upper rectum appeared normal, and proximal to this pseudopolyp formation was present. At this time, the patient was unwilling to undergo operation. In March 1992, clinical features of chronic large bowel obstruction were obvious. Investigations of the bowel lumen were limited by an impassible stricture at 30 cm, and a supervening carcinoma could not be excluded (Figure 53.1).