Conclusions
We present an unusual case of sarcoidosis in which the clinical presentation is best explained by an inflammatory mass in the region of the ampulla of Vater causing obstruction of the bile duct and pancreatic duct as well as intermittent duodenal obstruction. It is clear from previous reports that gastrointestinal exacerbations of sarcoidosis may occur during quiescent pulmonary disease. We are confident of the diagnosis because (1) the patient had a well-documented history of systemic sarcoidosis; (2) the obstruction responded to high-dose steroids promptly on two separate occasions; (3) biopsy of peripancreatic lymph nodes in the inflammatory mass was consistent with sarcoidosis; and (4) there was no clinical or radiographic evidence for Crohn's disease or any other granulomatous disorder. Our report indicates that small bowel obstruction must be added to the list of rare intra-abdominal complications of sarcoidosis.
Similar content being viewed by others
References
Ona FV: Gastric sarcoid: Unusual cause of upper GI hemorrhage. Am J Gastroenterol 75:286–288, 1981
Becker WF, Coleman WO: Surgical significance of abdominal sarcoidosis. Ann Surg 1153:987–995, 1961
Polachek AA, Matre WJ: Gastrointestinal sarcoidosis: A case involving the esophagus. Am J Dig Dis 9:429–433, 1964
Sprague R, Harper P, McClain S, Trainer T, Beecken W: Disseminated gastrointestinal sarcoidosis: Case report and review of the literature. Gastroenterology 87:421–425, 1984
Legrand I, Hassan M, Brauner M: Radiologic manifestations of splenic and gastroduodenal sarcoidosis. Review of two cases. J Radiol 69:39–43, 1988
Briley C, Jackson DC, Johnsrude IS, Mills SR: Acute Gastrointestinal hemorrhage of small bowel origin. Radiology 136:317–318, 1980
Ell SR, Frank PH: Spectrum of lymphoid hyperplasia: Colonic manifestations of sarcoidosis, infectious mononucleosis, and Crohn's disease. Gastrointest Radiology 6:3299–3332, 1981
Sagalow BR, Miller CL, Wechlser RJ: Pancreatic sarcoidosis mimicking pancreatic cancer. J Clin Ultrasound 16:131–134, 1988
Friedman HZ, Weinstein RA: Sarcoidosis of the pancreas. Arch Intern Med 143:2182–2183, 1983
Maher L, Choi H, Dodds WJ: Noncaseating granulomas of the pancreas. Am J Gastroenterol 75:222–225, 1981
Chaun H, King DM, Gofton JP, Sutherland WH, Bogach A: Sarcoidosis of the pancreas. Am J Dig Dis 17:725–730, 1972
Bloom R, Sybert A, Mascatello VJ: Granulomatous biliary tract obstruction due to sarcoidosis. Am Rev Respir Dis 117:783–787, 1978
Ryrie DR: Sarcoidosis with obstructive jaundice. J R Soc Med 47:879, 1954 (abstract)
Friedman HZ, Weinstein RA: Sarcoidosis of the pancreas. Arch Intern Med 143:2182–2183, 1983
Tinker MA, Viswanathan B, Laufer H, Margolis IB: Acute appendicitis and pernicious anemia as complications of gastrointestinal sarcoidosis. Am J Gastroenterol 79:868–872, 1984
Popovic OS, Brkic S, Bojic P, Kenic V, Jojic N, Djuric V, Djordjevic N: Sarcoidosis and protein losing enteropathy. Gastroenterology 78:119–125, 1980
Mitchell DN, Rees RJ, Goswami KK: Transmissible agents from human sarcoid and Crohn's disease tissues. Lancet 2:761–762, 1976
Kraft KC: Crohn's disease and sarcoidosis. N Engl J Med 285:1259–1260, 1971
Mitchell DN, Cannon P, Dyer NH, Hinson KFW, Willoughby JMT: The Kveim test in Crohn's disease. Lancet 2:571–572, 1969
Siltzbach LE, Vieira LOBD, Topilsky M, Janowitz HD: Is there Kveim responsiveness in Crohn's disease? Lancet 2:634–635, 1971
Israel HL, Goldstein RA: Relation of the Kveim antigen reaction to lymphadenopathy. N Engl J Med 284:345–349, 1971
Gronhagen-Riska C, Fyhrquist F, Hortling L, Koskimies S: Familial occurrence of sarcoidosis and Crohn's disease. Lancet 1:1287–1288, 1983
Willoughby JMT, Mitchell DN, Wilson JD: Sarcoidosis and Crohn disease in siblings. Am Rev Respir Dis 104:249–253, 1971
Padilla AJ, Sparberg M: Regional enteritis and sarcoidosis in one patient. Gastroenterology 63:153–160, 1972
Oakley JR, Lawrence DAS, Fiddian RV: Sarcoidosis associated with Crohn's disease of ileum, mouth, and oesophagus. J R Soc Med 76:1068–1071, 1983
McCormick PA, O'Donoghue DP, FitzGerald MX: Crohn's colitis and sarcoidosis. Postgrad Med J 62:951–953, 1986
Dines DE, DeRemee RA, Green PA: Sarcoidosis associated with regional enteritis. Minn Med 54:617–620, 1971
Lockhart-Mummery HE, Morson BC: Crohn's disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis. 1:87–105, 1960
Williams W: Histology of Crohn's syndrome. Gut 5:510–516, 1964
Robb-Smith AHT: A bird's eye view of Crohn's disease. Proc R Soc Med 64:157–161, 1971
Wanstrup J, Elling P: Immunohistochemistry of sarcoidosis. Acta Pathol Microbiol Scand 73:37–42, 1968
Elling P, Wanstrup J: Sarcoidosis. Immunological demonstration of immunoglobulin IgD in sarcoid lymph nodes. Acta Pathol Microbiol Scand 77:326–368, 1969
Morson BC: Histopathology of Crohn's disease. Proc R Soc Med 61:79–81, 1968
Watson CJ, Rigler LG, Wangensteen OH, McCartney JS: Isolated sarcoidosis of the small intestine simulating nonspecific ileojejunitis. Gastroenterology 4:30–52, 1945
Silverstein E, Friedland J, Lyons HA, Gourin A: Markedly elevated angiotensin-converting enzyme in lymph nodes containing nonnecrotizing granulomas in sarcoidosis. Proc Natl Acad Sci USA 73:2137–2141, 1976
Silverstein E, Fierst S, Simon MR, Weinstock JV, Friedland J: Angiotensin-converting enzyme in Crohn's disease and ulcerative colitis. Am J Clin Pathol 75:175–178, 1981
Schuffler MD, Chaffee RG: Small intestinal biopsy in a patient with Crohn's disease of the duodenum—The spectrum of abnormal findings in the absence of granulomas. Gastroenterology 76:1009–1014, 1979
Nugent FW, Richmond M, Park SK: Crohn's disease of the duodenum. Gut 18:115–120, 1987
Iwai K, Oka H: Sarcoidosis—report of 10 autopsy cases in Japan. Am Rev Respir Dis 90:612–622, 1964
Deutch SJ, Sandler MA, Tankanow LB: Abdominal lymphadenopathy in sarcoidosis. J Ultrasound Med 6:237–242, 1987
Scadding JG, Mitchell DN: Sarcoidosis, 2nd ed. London. Chapman and Hall Ltd, 1985
Miller LK, Rochester D, Miller JW: Clinical vignette: Extensive abdominal lymphadenopathy in sarcoidosis. Am J Gastroenterol 75:367–369, 1981
Schwarzchild W, Myerson RM: Venous insufficiency of the small intestine secondary to sarcoidosis of mesenteric lymph nodes. Am J Gastroenterol 50:69–72, 1968
Rohatgi PK, Singh R, Vieras F: Extrapulmonary localization of gallium in sarcoidosis. Clin Nucl Med 12:9–16, 1987
Kerley P. Sarcoidosis.In Modern Trends in Diagnostic Radiology. JW McLaren (ed.). New York, Hoebeer, 1948, p150
Siegel CI, Honda M, Salik J, Mendeloff AI: Dysphagia due to granulomatous myositis of the cricopharyngeus muscle: Physiographic studies prior to and following successful surgery. Trans Am Acad Physicians 74:342–352, 1961
Palmer ED: Note on silent sarcoidosis of the gastric mucosa. J Lab Clin Med 52:231–234, 1958
Fung WP, Foo KT, Lee YS: Gastric sarcoid presenting with hematemesis. Med J Aust 2:47–49, 1975
Berens DL, Montes M: Gastric sarcoidosis. NY State J Med 75:1290–1293, 1975
McLaughlin JS, Van Elk W, Thayer W, Albrink WS, Hayes MA: Gastric sarcoidosis. Ann Surg 153:283–288, 1961
Chinitz MA, Brandt LJ, Frank MS, Frager D, Sablay L: Symptomatic sarcoidosis of the stomach. Dig Dis Sci 30:682–688, 1985
Curran JF, Curran JF: Boeck's sarcoid of pancreas. Surgery 28:574–577, 1950
Curtis AC, Grekin RH: Sarcoidosis. Med Clin North Am 33:31–54, 1949
Freed JS, Reiner MA: Acute cholecystitis as a complication of sarcoidosis. Arch Intern Med 143:2188–2189, 1983
Bloom R, Sybert A, Mascatello VJ: Granulomatous biliary tract obstruction due to sarcoidosis. Am Rev Respir Dis 117:783–787, 1978
Lloyd-Davies RW, Forbes GB: Sarcoidosis of the gallbladder. Gastroenterology 49:287–290, 1965
Miyamoto, Nomura S, Kudo E, Hamamoto Y: An autopsy case of sarcoidosis in the intestinal canal. Bull Osaka Med Sch 18:48–55, 1972
Legrand I, Hassan M, Brauner M: Radiologic manifestations of splenic and gastroduodenal sarcoidosis. Review of two cases. J Radiol 69:39–43, 1988
Rauf A, Davis P, Levendoglu H: Sarcoidosis of the small intestine. Am J Gastroenterol 83:187–189, 1988
Bulger K, O'Riordan M, Purdy S, O'Brien M, Lennon J: Gastrointestinal Sarcoidosis Resembling Crohn's Disease. Am J Gastroenterol 83:1415–1417, 1988
Macleod JB: Sarcoidosis involving the vermiform appendix. J R Coll Surg Edinb 10:319–323, 1965
Munt PW: Sarcoidosis of the appendix presenting as appendiceal perforation and abscess. Chest 66:295–297, 1974
Shinefeld WT, Rubinow M: Noncaseating epithelioid granuloma of the appendix (localized sarcoid disease?). J Int Coll Surg 42:1–4, 1964
Bystrom J: Localized sarcoidosis of the appendix simulating MB Crohn. Acta Chir Scand 134:163–165, 1968
Clarke H, Pollett W, Chittal S, Ra M: Sarcoidosis with involvement of the appendix. Arch Intern Med 143:1603–1604, 1983
Raven RW: The surgical manifestations of sarcoidosis. Ann R Coll Surg Engl 5:3–28, 1949
MacFarlane DA: Intestinal sarcoidosis. Br J Surg 42:639–642, 1955
Gourevitch A, Cunningham IJ: Sarcoidosis of the sigmoid colon. Postgrad Med J 35:689–691, 1959
Longcope WT, Freiman DG: A study of sarcoidosis; based on a combined investigation of 160 cases including 30 autopsies from the Johns Hopkins Hospital and the Massachusetts General Hospital. Medicine 31:1–132, 1952
Aaronson HG, Meir JH, Ulin AW: A case of sarcoidosis of the colon. J A Einstein Med Center 6:14–16, 1957
Kohn NN: Sarcoidosis of the colon. J Med Soc NJ 77:517–518, 1980
Gould SR, Handley AJ, Barnardo DE: Rectal and gastric involvement in a case of sarcoidosis. Gut 14:971–973, 1973
Tobi M, Kobrin I, Ariel I: Rectal involvement in sarcoidosis. Dis Colon Rectum 25:491–493, 1982
Konda J, Ruth M, Sassaris M, Hunter FM: Sarcoidosis of the stomach and rectum. Am J Gastroenterol 73:516–518, 1980
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stampfl, D.A., Grimm, I.S., Barbot, D.J. et al. Sarcoidosis causing duodenal obstruction. Digest Dis Sci 35, 526–532 (1990). https://doi.org/10.1007/BF01536930
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01536930