Case 5
A 21 year old male who received anti-TB therapy for ileal stricture and later underwent right hemi-colectomy (operative biopsy showed Crohn’s disease) - was on Azathioprine.
Now he developed peri-anal fistula.
After incision and drainage there is persistent fistula discharge.
Colonoscopy showed rectal ulcers with mild luminal narrowing, Trnas-rectal USG/MRI showed trans-sphincteric fistula with small (1x 1 cm) abscess.
Next step?
Biologics
EUA+ seton followed by infliximab
Antibiotics
Azathioprine
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EUA plus infliximab