Crohn disease (complicated)

Case contributed by Dr Varun Babu

Presentation

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

Patient Data

Age: 20 years old
Gender: Male
MRI

Contrast enhanced MRI abdomen and pelvis

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

Contrast enhanced CT abdomen and pelvis a week after attempted drainage

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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Case information

rID: 45203
Published: 18th May 2016
Last edited: 29th Aug 2019
Inclusion in quiz mode: Included

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