Neo-terminal ileal stricture - Crohn disease

Case contributed by Derek Smith
Diagnosis almost certain

Presentation

Crohn disease initially diagnosed in 1980s and underwent right hemicolectomy with terminal ileal resection. Relatively stable since then with no medication. Presented with right iliac fossa pain and peritonitis, with raised inflammatory markers.

Patient Data

Age: 80 years
Gender: Female

Gas filled bowel loops within normal dimensions.

No evidence of obstruction or perforation.

Evidence of right hemicolectomy with ileocolic anastomosis.

Just proximal to the anastomosis, there is luminal narrowing with mucosal thickening and contrast enhancement.  The small bowel is inflamed and distended proximal to this narrowing. There is an additional segment of inflamed ileum and also enhancement and thickening of the gastric wall.

No perforation or intra-abdominal collection.  Multiple enlarged small intestinal mesentery nodes and prominent vascular structures.

Liver, gallbladder, adrenals and spleen are unremarkable in appearance. The pancreas is mildly atrophic. Small cortical cysts in right kidney and left kidney contains two small calculi.

Case Discussion

This patient who had stable Crohn disease for a number of years was recently investigated for weight loss and had an unremarkable colonscopy up to the anastomosis six months prior to admission.

She received IV steroid and antibiotic therapy before starting a monoclonal agent.

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