Crohn's disease onset associated with a ballistic injury to the abdomen in the patient wounded in the war in Ukraine: a case report.

Abstract

Background: The Russo-Ukrainian war is ongoing warfare that is associated with severe injuries among the civil population and military personnel. The aim of this study was to demonstrate a rare case of Crohn's disease manifestation in a combat patient in relation to a ballistic injury to the abdomen in the ongoing war in Ukraine.

Case presentation: A male Caucasian Ukrainian patient 34 years of age received a ballistic injury to the abdomen due to artillery shelling. During the next 22 days, the patient underwent bowel resections with anastomosis as well as several relaparotomies for abdomen revision and lavage. On the 23rd day, the patient was diagnosed with gastrointestinal bleeding. An esophagogastroduodenoscopy showed no signs of active bleeding, but longitudinal ulcers with a cobblestone appearance were detected, which is typical for Crohn's disease. Sulfasalazine at a dose of 3.0 g per day was prescribed to the patient. On the 25th day after the injury, the patient was diagnosed with intestinal bleeding and peritonitis, indicating perforation. At relaparotomy, a perforated ulcer 0.5 cm × 0.5 cm with even and well-defined borders was identified in the jejunum located 10 cm from the Treitz ligament. The ulcer was excised, and the intestine defect was sutured, followed by retrograde intubation of the jejunum. Until the 40th day after the injury, the patient underwent conservative treatment. The patient died on the 40th day after the injury due to multiple organ dysfunction syndrome, which was associated with respiratory failure (pneumonia) and severe intoxication.

Conclusion: Ballistic injury to the abdomen might be a trigger for the onset of Crohn's disease. Patients with intestinal bleeding and stress ulcers should be evaluated for concomitant gastroenterological disorders, and appropriate clinical investigations and management should be applied.