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Background: An association between small bowel adenocarcinoma and Crohn’s Disease (CD) is well-established. Crohn’s-related small bowel cancers are male predominant, distal, surrounded by dysplasia, and carry a poor prognosis, particularly in the setting of excluded intestinal loops. As suggested in an earlier published series from our center (1991), clinical indicators of small bowel cancer in CD include recurrent obstructive symptoms after periods of quiescence and bowel obstruction that is refractory to conservative management.¹ We present our recent experience with this entity in order to further elucidate its clinicopathological features and clinical indicators.Methods: A retrospective review was undertaken of all surgical patients with small bowel adenocarcinoma and CD seen at our institution between 1994-2009. The data included demographics, pathology, hospital and post-operative course. Follow-up was assessed until time of death or by interview with survivors. Patients were classified into two groups according to lymph node status (Stages 1&2 vs. 3&4); survival was calculated for all patients and compared between these groups using Kaplan Meier curves.Results: 28 patients (9F, 19M) were identified and followed for a median of 2 years. The median age at onset of CD symptoms was 25, and the median age at cancer diagnosis was 54.9, for a mean interval of 28.3 years. Twenty-one cancers were ileal and five were jejunal. There were no cancers in excluded intestinal loops. Significant differences in 2-year survival were determined for: node-negative (83.3%, 95%CI 62.4-14.5%) versus node-positive cancers (45.5 %, 95%CI 17.7-73.3%), and for localized (90.9%, 95%CI 73.8-108%) versus metastatic disease (33.3%, 95%CI 6.6-60%). Overall 36-month survival was 68% (95%CI 49.6-86.4%), compared to 40% among those without excluded loops in our series from 1991. Fifteen of 22 patients had long periods of quiescent disease before diagnosis (7-45 years), and 13 of 22 patients required surgery for refractory bowel obstruction. Adequate information was not retrievable for 6 patients. Conclusions: A comparison to our previous series reveals similar male predominance, long duration to development of cancer, and a high rate of node-positive cancer at diagnosis. Our findings also confirm 2 important clinical indicators of malignancy: recrudescent symptoms after long periods of relative quiescence, and persistent small bowel obstruction that is refractory to medical therapy.¹Ribeiro MB, Greenstein AJ, Heimann TM, Yamazaki Y, Aufses AH Jr., Surg Gynecol Obstet. 1991 Nov;173(5):343-9.