Acute intestinal obstruction revealing an undiagnosed jejunal sarcoidosis in a 59-year-old female.

BACKGROUND

Sarcoidosis is a granulomatous illness with no known cause, defined histopathologically by noncaseating granulomas. While 90% of cases involve the lungs and mediastinal lymph nodes, clinically recognizable gastrointestinal sarcoidosis occurs in only 0.1-0.9% of patients, with small bowel involvement occurring in as few as 0.03% of all cases, and when it does occur, it is usually late in the disease course in patients with multisystem disease.

CASE PRESENTATION: Herein, we report a case of 59-year-old patient who presented with a picture of complete jejunal obstruction and gastrointestinal bleeding. Imaging revealed jejunal thickening and mesenteric lymphadenopathy. Later, intra-operatively, it be found caused by a jejunal stricture and enlarged mesenteric lymph nodes secondary to an undiagnosed sarcoidosis. Postoperative complications included hepatic hematoma and gastrointestinal bleeding. She stabilized after multidisciplinary management. A 1-year follow-up showed mediastinal lymphadenopathy without pulmonary involvement.

DISCUSSION: To provide individualized therapeutic care and follow-up, gastrointestinal sarcoidosis is a complex, possibly lethal condition that requires a multidisciplinary approach and early clinical suspicion. Without a prior diagnosis, sarcoidosis must be taken into account as a possible cause of acute intestinal blockage.

CONCLUSION

Our case of jejunal sarcoidosis is unique for the rarity of disease location, the lack of pre-existing diagnosed sarcoidosis, and the necrotized jejunal resected segment indicating bowel ischemia.