• 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