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A 38-year-old Myanmar Thai gentleman with known case of hemoglobin E disease presenting to us with anemia (Hemoglobin 7.3 g%) for further endoscopic evaluation. He had a history of severe acute gastroenteritis (diarrhea and vomiting for 2 days) one month ago requiring hospital admission where he was found to have anemia. He had a history of unhealed perianal abscess for six months duration. No obvious discharge was recognized. Physical examination did not find any abnormalities.

Upper GI endoscopy showed multiple apthous ulcers from first part of duodenum to proximal jejunum (the upper GI endoscopy ended).

Colonoscopy showed similar multiple apthous ulcers inside the terminal ileum from IC valve to 20 cm away from IC valve.

Biopsy from duodenum and jejunal ulcers and terminal ileum ulcers were examined by two pathologists.

Background Illness:

2011

Initially diagnosed as Ulcerative colitis (pancolitis) and started on Mesalamine.

2012

I would expert opinion on a clinical issue. 17 year boy diagnosed with CD when presented with history of recurrent oral ulcers, scrotal ulcer, mild iron deficiency and abdominal pain of near 1 year duration. He was started on Azathioprine, Pentasa. The scrotal ulcer and abdominal pain has improved the CRP came down from 60 to 10 and calprotectin came down from 600 to 70. The issue is the oral ulcers are persistent. The boy is based in Abu Dhabi but he is of Indian origin. He could not tolerate oral budesonide. I am confused on what add to control the oral ulcers. I was planning to start on infliximab but the improvement in the parameters and other symptoms without infliximab has confused me. Which may be a safer alternative to infliximab which will help with oral ulcers. I would like get an expert opinion.

Thanks Dr Arun Korah Gastroenterologist…

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

• 12 Years old girl underwent open appendectomy for appendicular perforation on 25-may-2020.

• She was apparently asymptomatic till June 2020 when she followed up with complaints of opening up of previous incision wound with pus discharge.

• She was treated conservatively with antibiotics according to pus culture sensitivity report .

• Since then her wound hasn’t healed and she is having persistent discharge.

Wound dehiscence in June 2020.

Nov 2019

• Large volume watery loose stools (10-12 episodes) (nocturnal) with occasional drops of blood, tenesmus and urgency

• No associated pain abdomen, borborygmi, fever or vomiting

• UGIE- normal

• CT enterography- normal

• Sigmoidoscopy- diffuse loss of vascular pattern with erythema and multiple superficial ulcers in rectum and sigmoid

1. What’s the recommended duration to treat with Metronidazole - is it 14days?

2. How would you monitor complete resolution of disease?

3. How long would the endoscopic mass take to resolve?

On Behalf of Dr. Nilesh Fernandopulle, Sri Lanka

An 8-year child was suffering from recurrent abdomen pain from past 2year. Few symptoms like Poor weight gain, Diarrhea for over 2 months was being observed. On blood sample analysis it was seen that the patient was suffering from Anemia, thrombocytosis and the platelet count was 11 Lakhs. The erythrocyte sedimentation rate was high (ESR). On performing sigmoid colon biopsy, it was seen that the child had mild erosions and mild mucosal edema with non-specific inflammation.

It is suspected that the child might have Small Bowel Crohn's disease or any other differentials

A 15 month old infant had symptoms like Chronic diarrhea. On blood report analysis it was evaluated that the infant has Anemic conditon, Thrombocytosis, High ESR ( Erythrocyte Sedimentation Rate ) and CRP (C-Reactive Protein).

Further to confirm the diagnosis Colonoscopy for performed which resulted in Terminal Ileum Small ulcers.

UGIE normaland colon were normal, MR Enterography was ileum.

To confirm the further the stage of ulcer biopsy of ileum is sent and awaiting for the result.