A 38 years old patient was diagnosed with Crohn's disease for more than 26 years
A 38 Years old patient was suffering from Crohn's disease for over 26 years.
Stricturing and penetration of small & large bowel were performed. He was also diagnosed with the perianal disease(Complex fistula).
So far conservatively the disease has been managed.
TNF Agents - Developed Serum Sickness-? Antibodies to anti-TNF Agents
Azathioprine -> Anemia
Responded to vendolizumab initially -> Post Covid exacerbation of symptoms - not responding to vendolizumab + Steroid
Endoscopy: not able to cross sigmoid stricture (2 Years)
MRI Pelvis 01.06.21
Complex low rectal fistula with translevator course and significant inflammatory changes
Small intersphincteric abscess
Sigmoidoscopy 01.06.21 - Multiple deep irregular ulcers and polypoidal lesions(? Pseudopolyps) with friable mucosa causing luminal narrowing. Scope could not be negotiated beyond.
Bx - Moderately active inflammation with mucoid lymphoid hyperplasia in a know case of Crohn's disease
March 2020
July 2020
June 2020
At Present, Since 15 Days:
Watery stools- 15/20 days - Small volume- no blood/ mucus
Bloating
Weight loss 8Kg in 15 days
H/o repeated admissions for similar complaints for 3 months (Vedolizumab restated post covid)
22.07.21
Hb - 11.1
TLC- 12000
Plat 3.4 lakhs
Alb - 4.1
Next Option??
Kindly share us your comment
This looks like complicated perianal fistulizing disease. Infliximab with Azathioprine would have been the best therapy. As patient cannot take these and no response to Vedolizumab with present of tight stricture in colon best will be diversion end ileostomy.