Crohn's Disease Requiring Different Surgical Interventions in Presumed Monozygotic Twin Brothers: A Case Report.
- 1Department of Surgery, The Fraternity Memorial Hospital, Tokyo, Japan.
- 2Department of Pathology, The Fraternity Memorial Hospital, Tokyo, Japan.
Abstract
Crohn's disease (CD) in both members of a presumed monozygotic twin pair is uncommon. We report twin brothers who developed ileocolonic and perianal CD 2 years apart but required different surgical interventions. This report highlights the value of prompt evaluation of a symptomatic cotwin and individualized surgical decision-making. Twin 1 developed a perianal abscess at the age of 16 years, followed by severe rectosigmoid inflammation and fixed stenosis. Endoscopy demonstrated rectosigmoid mucosal necrosis, ileocecal scarring, and longitudinal ulcer scars in the small bowel, and biopsy specimens contained epithelioid granulomas. Recurrent obstructive symptoms led to an anterior resection. Twin 2 developed a perianal abscess at the age of 18 years. Because his cotwin had CD, he underwent early ileocolonoscopy, which showed longitudinal ulcers extending from the terminal ileum to the cecum and aphthous ulcers throughout the colorectum. A symptomatic low intersphincteric fistula was treated by seton drainage, and curetted tissue contained epithelioid granulomas. Both brothers initially received vedolizumab after surgery. All seton-related drains in Twin 2 were removed 3 months postoperatively. Drainage from the fistula recurred at 6 months, prompting a switch from vedolizumab to adalimumab; the drainage ceased 1 month later. Zygosity was reported by the patients and their family but was not genetically confirmed. Twin 1 remained free of recurrent obstruction for more than 2 years. This rare presumed monozygotic twin pair showed close concordance in the age at onset, ileocolonic and perianal involvement, and granulomatous histology, while requiring different operations and postoperative medical strategies. Their clinical courses underscore the importance of asking about family history, promptly investigating gastrointestinal or perianal symptoms in a cotwin, and individualizing treatment over time. Further accumulation of well-characterized twin cases with objective zygosity assessment and long-term follow-up may clarify the shared and divergent clinical features of CD.
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BibTeX
@article{matsunaga2026crohns,
title = {{Crohn's Disease Requiring Different Surgical Interventions in Presumed Monozygotic Twin Brothers: A Case Report.}},
author = {Keigo Matsunaga and Keiji Matsuda and Tatsuki Kotani and Kentaro Abe and Rie Kondo and Kiyohiko Omichi and Takeshi Nishikawa and Wataru Masuda},
journal = {Surgical case reports},
year = {2026},
month = nov,
doi = {10.70352/scrj.cr.26-0663},
url = {https://europepmc.org/article/MED/42997087},
note = {CC BY},
}
RIS
TY - JOUR
TI - Crohn's Disease Requiring Different Surgical Interventions in Presumed Monozygotic Twin Brothers: A Case Report.
AU - Keigo Matsunaga
AU - Keiji Matsuda
AU - Tatsuki Kotani
AU - Kentaro Abe
AU - Rie Kondo
AU - Kiyohiko Omichi
AU - Takeshi Nishikawa
AU - Wataru Masuda
PY - 2026
DA - 2026/11/05
JO - Surgical case reports
DO - 10.70352/scrj.cr.26-0663
UR - https://europepmc.org/article/MED/42997087
AB - Crohn's disease (CD) in both members of a presumed monozygotic twin pair is uncommon. We report twin brothers who developed ileocolonic and perianal CD 2 years apart but required different surgical interventions. This report highlights the value of prompt evaluation of a symptomatic cotwin and individualized surgical decision-making. Twin 1 developed a perianal abscess at the age of 16 years, followed by severe rectosigmoid inflammation and fixed stenosis. Endoscopy demonstrated rectosigmoid mucosal necrosis, ileocecal scarring, and longitudinal ulcer scars in the small bowel, and biopsy specimens contained epithelioid granulomas. Recurrent obstructive symptoms led to an anterior resection. Twin 2 developed a perianal abscess at the age of 18 years. Because his cotwin had CD, he underwent early ileocolonoscopy, which showed longitudinal ulcers extending from the terminal ileum to the cecum and aphthous ulcers throughout the colorectum. A symptomatic low intersphincteric fistula was treated by seton drainage, and curetted tissue contained epithelioid granulomas. Both brothers initially received vedolizumab after surgery. All seton-related drains in Twin 2 were removed 3 months postoperatively. Drainage from the fistula recurred at 6 months, prompting a switch from vedolizumab to adalimumab; the drainage ceased 1 month later. Zygosity was reported by the patients and their family but was not genetically confirmed. Twin 1 remained free of recurrent obstruction for more than 2 years. This rare presumed monozygotic twin pair showed close concordance in the age at onset, ileocolonic and perianal involvement, and granulomatous histology, while requiring different operations and postoperative medical strategies. Their clinical courses underscore the importance of asking about family history, promptly investigating gastrointestinal or perianal symptoms in a cotwin, and individualizing treatment over time. Further accumulation of well-characterized twin cases with objective zygosity assessment and long-term follow-up may clarify the shared and divergent clinical features of CD.
SN - 2198-7793
ER -