73 Yrs Male with Hypertension, Chronic obstructive pulmonary disease (COPD), Dilated cardiomyopathy (DCM)
• Presented intermittent pain abdomen a/w abdominal distension, nausea since 6 months
• h/o weight loss ~10kg/6m
• 2-3 semisolid to liquid stools, uses laxatives, no blood or mucous
o/s evaluation
Colonoscopy
• Terminal ileal stricture at 5 cm from IC valve, scope not negotiable -? IBD – CD / kochs
• Bx – non specific ileitis, MTB PCR => Negative
MRI enterography
• Long segment ileal thickening with luminal narrowing
• Ileo vescical fistula
• Started on Pentasa and Budez- CR
• patient presented to us with abdominal distension and pain , constipation à treated conservatively , passed flatus, stools not passed
CBC - 10.2/12200/4.9
S.CREATNINE - 1.0
LFT - 0.5/0.1
ESR - 26
cue - Plenty of pus cells => E.COLI
Issues
• Elderly male with comorbidities and moderate LV dysfunction (LVEF 42%)
• Fistuliuzing crohns disease with recurrent SAIO
• Urinary tract infection (preclude BIOLOGICS)
• SURGERY => high risk because of co-morbidities
Excellent comment by Dr. Rajendra. UTI can be treated with prolonged high-potency antibiotics before starting biologics. Also, VEDO & USTE will not have an adverse outcome in UTI. My question is, can we try some form of closing device here?