• 2014 --- Increased frequency of SAIO
• Surgery – (15/01/2014): Lap CCx + ileocaecal & ileal resection with ileo-ascending anastomosis.
Op findings
– Thin walled distended GB with multiple calculi
– Long segment distal ileal stricture (2 feet) with fat creeping
– Stricture extending till IC junction
– Omentum densely adherant to caecum & abdominal wall
Complicated (21/01/2014) --- Re-exploration
– Ascending colonic gangrene near anastomotic site with fecal peritonitis (Rt lower abdomen)
June 2014
• Restoration surgery for ileo-colonic continuity + adhesiolysis
• Biopsy – benign stricture with focal mucosal ulcerations with foci of fissure like ulceration with mild crypt disarray, submucosal fibrosis & transmural inflammation with focal fat wrapping, no granulomas --- Crohn’s disease > CMUSE
• Started on 5-ASA and Azathioprine --- Continued till 2020
• Regular follow-up & treatment compliant
• Minor flares over past 6 yrs
• No steroids / biologics
• Symptomatic since Oct 2020 --- abdominal pain, bilious vomiting's – Recurrent SAIO
• CBC, RFT, LFT – Normal
• Fecal calprotectin - 384 mg/kg
• Colonoscopy - circumferential ulceration at anastomotic site but no narrowing, aphthous ulcers with mucosal edema at neo-terminal ileum, no stenosis
• CECT – Dilated jejunal loops, collapsed loops of terminal ileum with narrowing in neo-terminal ileum -? due to adhesions
18/12/2020

29/12/2020
