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Crohn disease (complicated)

Case contributed by Varun Babu
Diagnosis certain

Presentation

Right lower quadrant pain in a known patient of Crohn disease.

Patient Data

Age: 20 years old
Gender: Male

C+ MRI abdo/pelvis

mri
  • mural thickening and hyperenhancement of terminal ileum. 
  • fistulous track seen from terminal ileum communicating with a multiloculated right iliopsoas abscess. 

1wk after attempted drainage

ct

Post drainage, there are multiple air foci within the right iliopsoas abscess and now it is seen to bulge through the anterior abdominal wall. 

Case Discussion

Bowel perforation secondary to mural inflammation leading to fistulous tracking and secondary abscess / phlegmon formation is commonly encountered. Such complications warrant repetitive antibiotic cover with drainage measures and makes the management a lot more cumbersome. This patient is making his second visit to the hospital in 9 months with recurrence of psoas abscess formation warranting drainage. 

 

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