Abdominal Crohn’s Disease
14 results
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Benign Disease- You are asked to evaluate a 32-year-old woman who reports bloating, abdominal pain, and incomplete evacuation. She underwent restorative total proctocolectomy/ileal pouch anal anastomosis (IPAA) with S-pouch 4 years ago for chronic ulcerative colitis (UC). Computed tomography (CT) of the abdomen and pelvis with oral and intravenous (IV) contrast did not show any evidence of small bowel obstruction. Pouchoscopy was without evidence for inflammation. Contrast pouchogram showed a 7-cm long conduit connecting the pouch to the anus. What is the most likely diagnosis?
- A 36-year-old patient with ulcerative colitis (UC) underwent total proctocolectomy with ileal pouch anal anastomosis (IPAA) 3 years ago. The patient presents now with lower abdominal discomfort that is associated with bloody loose stools. Endoscopy shows erythematous friable rectal cuff with deep ulcers. The rest of the pouch appears normal. What is the most appropriate treatment?
- A 25-year-old man with ulcerative colitis (UC) is 2 years status post restorative proctocolectomy with J-pouch. He was doing well until 5 weeks ago, when he developed moderate pelvic abdominal pain and a significant increase in the frequency of his bowel movements (>10/day). Dietary changes did not improve the symptoms. Pouchoscopy revealed moderate severity diffuse erythema and friability, with exudates and erosions. Stool cultures are negative for any growth. The best next step in treatment for this patient is
- A 58-year-old male nonsmoking patient underwent an ileocolic resection for Crohn’s disease with a fibrostenotic stricture. Following surgery, the patient opted to not receive medical therapy for Crohn’s disease. Six months following surgery, a surveillance colonoscopy reveals a Rutgeerts score of i3 lesions. The patient reports mild, daily right-sided abdominal pain. Which of the following is the most appropriate next step for the management of this patient?
- A 43-year-old woman presents to the emergency room with 24 hours of nausea, vomiting, and bloating. She has history of Crohn’s disease with no prior surgery and is currently not taking any medications. She smokes one pack of cigarettes per day. Computed tomography (CT) is obtained (see figure below). Magnetic resonance enterography (MRE) shows mucosal edema and hyperenhancement. She is treated with intravenous (IV) fluid resuscitation, bowel rest, and nasogastric decompression. Inpatient colonoscopy performed 4 days later demonstrates inflamed ileal mucosa and narrowed lumen. What is the best next step in this patient’s management?
- A 15-year-old patient with 3-year history of Crohn’s disease presents with abdominal pain, nausea, and vomiting. Which of the following modalities is recommended to evaluate for small bowel disease?
- A 23-year-old woman with a longstanding history of fistulizing Crohn’s disease reports diarrhea and abdominal pain. Computed tomography (CT) enterography shows an ileosigmoid fistula. After medical optimization, the fistula persists. Sigmoid colon mucosa is unremarkable on colonoscpy. What is the best next step in management?
- A 55-year-old man presents with abdominal pain and rectal bleeding. He has a 20-year history of Crohn’s proctocolitis and has perianal disease. He was treated with infliximab for 5 years but developed anti–tumor necrosis factor (TNF) antibodies. He had an allergic reaction to adalimumab. He has been on usketinumab for the past year with minimal improvement. You drained two prior perirectal abscesses and placed setons in the past 2 years. He currently has minimal complaints from the indwelling setons. A recent colonoscopy confirmed the persistence of chronic active proctosigmoiditis without evidence of dysplasia on multiple biopsies. He reports signficant disruption of his life and work and "wants this disease controlled, even if it means an ostomy." On physical examination, the abdominal is soft and minimally tender. Anorectal examination shows a well-controlled transphincteric fistula with seton without evidence of sepsis. Which of the following surgical options is most appropriate for this patient?
- A 34-year-old otherwise healthy woman, who underwent total abdominal colectomy with end ileostomy 1 year ago for fulminant Crohn’s disease colitis, presents to the office with ongoing bloody mucoid discharge per rectum and tenesmus. On examination, her abdomen is unremarkable with end ileostomy. Ileostomy is healthy and pouches well. Rectal examination is remarkable for normal perineal skin, normal tone, and absence of fistula and fissure. She has been through four different biologics. Endoscopy shows deep ulcers in the rectum with mucosal friability. She has bothersome mucoid anal discharge multiple times per day and wishes to know whether this can be resolved. Her small bowel disease was previously active and is now quiescent on entyvio. What is the best next option in her management?
- A 45-year-old patient presents to the emergency department with diarrhea and abdominal cramping 48 hours after eating raw oysters. Which is the most likely cause?
- A 42-year-old previously healthy woman presents to the emergency department with 2 weeks of right lower quadrant abdominal pain and diarrhea. Computed tomography (CT) of the abdomen and pelvis shows terminal ileitis and associated enlarged mesenteric lymph nodes. Serologic testing for which of the following should be performed?
- Anorectal Disease
- A 55-year-old patient presents with fever, pelvic pain, and painful bowel movements. On examination, she is found to have an anal fistula without induration or perirectal abscess. Her white blood cell count is 29,000. After fluid resuscitation and broad-spectrum antibiotics, vital signs return to normal. Magentic resonance imaging (MRI) of the pelvis is obtained (media). What is the best next step in her management?
- A 34-year-old male who engages in anal receptive intercourse presents to the clinic with a 2-week history of rectal pain, bright red bleeding, tenesmus, and persistent diarrhea. He has family history of Crohn’s disease. Urgent colonoscopy reveals normal ileum and colon but moderate proctitis with patchy ulcerations and copious amounts of mucus. Rectal cultures and biopsy results are pending. The most appropriate next step in management is
- Perioperative