Abdominal Crohn’s Disease
19 results
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Benign Disease- A 44-year-old man with known stricturing gastroduodenal Crohn’s disease with prior dilations who is receiving maximal medical therapy is admitted for increasing upper abdominal pain, nausea, vomiting, and weight loss. On endoscopy, obstructing duodenal stricture is noted. The esophagogastroduodenoscopy scope could not traverse this area. After nasogastric decompression, his best treatment option is:
- A 48-year-old woman with Crohn’s disease presents to the clinic for evaluation of right lower quadrant abdominal pain. Her surgical history is significant for proctocolectomy with end ileostomy. What began as a small pustule adjacent to her ileostomy has rapidly progressed into a painful 1-cm ulcer (Figure). Physical examination demonstrates peristomal ulcerations with serpiginous, irregular, and violaceous borders. The most appropriate management for this patient is:
- A 45-year-old man presents to your office with complaints of bloating, constipation, and intermittent diarrhea over the last 3 months. He has a 20-year history of Crohn’s disease and is currently receiving biologic therapy. On physical examination, he is mildly distended, without peritonitis. Colonoscopy confirms a sigmoid stricture that cannot be traversed. The most appropriate treatment is:
- A 65-year-old man presents with abdominal pain, 15-lb (6.8-kg) weight loss, rectal bleeding, diarrhea, and joint pain. He had recently started taking prednisone for rheumatoid arthritis. On endoscopy, he is noted to have mucosal friability and ulcerations with pseudopolyps in the descending colon with rectal sparing. His terminal ileum is normal. Which finding is associated with a diagnosis of Crohn’s disease?
- A 55-year-old man presents with severe refractory ulcerative colitis. He was admitted to the hospital and placed on parenteral steroids. He is now receiving salvage therapy with infliximab, but is not responding. The best next step in management is to:
- A 28-year-old man with a history of ulcerative colitis undergoes a total proctocolectomy with stapled ileal pouch–anal anastomosis. Six months after surgery, he presents with urgency, increased stool frequency, and bloody bowel movements. Endoscopic examination findings are shown (Figure A and B). What is the best next step in management?
- A 45-year-old man with history of ulcerative colitis presents for endoscopic assessment of his J-pouch after experiencing occasional bleeding, urgency, and abdominal pain for the past 3 months. He does not smoke or use nonsteroidal anti-inflammatory drugs; he was unresponsive to antibiotics and topical mesalamine preparations. Endoscopic images of the pouch and prepouch ileum are shown (Figures 1 and 2). What is the most likely histologic finding from the biopsies?
- An 18-year-old man with a 2-year history of Crohn’s disease treated with budesonide and 6-mercaptopurine is admitted for increased right lower quadrant pain, diarrhea, and weight loss. Computed tomography shows an ileal phlegmon. Colonoscopy shows significant deep ileal ulcers and erythema in the transverse colon. The best next step in management is:
- A 25-year-old man presents to the emergency department with worsening intermittent, colicky abdominal pain of 1 week’s duration. He has experienced several weeks of irregular bowel habits and loose stools. Examination reveals right lower quadrant tenderness without guarding or rebound; his white blood cell count is 20,000/µL (20109/L) with 80% polymorphonuclear leukocytes. Computed tomography reveals marked edema of the terminal ileum with a comb sign, a loss of fat planes, and narrowing of the lumen. The appendix is not seen. What is the best next step in management?
- You are consulted on a 43-year-old woman with Crohn’s disease, who underwent a balloon dilation procedure for an ileocolic stricture 4 months ago. She is now admitted to the hospital with complaints of right lower quadrant pain that radiates through her right lower extremity, diarrhea, and abdominal distention. Her white blood cell count is 15,000/µL (15109/L), and examination reveals right lower quadrant tenderness without peritonitis. She is currently receiving prednisone and biologic therapy for her Crohn’s disease. Imaging is shown (Figure). In addition to intravenous antibiotics, what is the most appropriate next step in management?
- A 28-year-old woman with a 12-year history of Crohn’s disease presents with cramping abdominal pain, a 15-lb (6.8-kg) unintentional weight loss, and recurrent emesis. She has been taking infliximab maintenance therapy for the last 4 years. Magnetic resonance enterography demonstrates multiple short strictures over a 15-cm portion of the mid-jejunum with decompressed distal small bowel. Colonoscopy shows no active perianal or colonic disease. What is the best definitive treatment?
- A 50-year-old man with a history of ulcerative colitis presents for follow-up 6 months after emergent total abdominal colectomy with end ileostomy. He complains of pain and persistent drainage from the perianal area. Ileoscopy is normal. The pathology report from his surgical specimen demonstrates full-thickness inflammation and granulomas. What is the most appropriate next step?
- Anorectal Disease
- A 34-year-old man has a constant, “dull ache” of the lower rectum accompanied by intermittent spontaneous rectal discharge. Imaging reveals a supralevator abscess with direct extension through the levators to the ischiorectal fossa. What is the next step in treatment?
- A 40-year-old woman with a history of Crohn's disease presents to your office with quiescent proctitis and a 4-mm rectovaginal fistula just above the anorectal ring. There is no appreciable sphincter defect. What is your best recommendation for repair?
- A 52-year-old woman presents with a distal recurrent rectovaginal fistula after 2 failed endorectal advancement flap repairs. She had normal findings on colonoscopy and endorectal ultrasonography confirmed a rectovaginal fistula in the very distal rectum with an intact sphincter complex and seton in place. What is the best next surgical treatment?
- An obese 45-year-old man presents for follow-up after undergoing a bedside incision and drainage of a recurrent left ischiorectal abscess. On examination, you observe a draining left ischiorectal surgical site as well as a right ischiorectal skin punctum that has been draining for several months. What is the most likely underlying cause?
- Malignancy
- A 50-year-old woman was found to have a right colon adenocarcinoma on screening colonoscopy. The tumor shows a loss of MMR function. Her family history is significant for uterine and pancreatic cancer. The rest of the imaging is negative for metastatic disease. What is the most appropriate next step in treatment?
- A 48-year-old postmenopausal female with no family history of colon cancer is diagnosed with a cecal adenocarcinoma. Staging reveals no evidence of metastatic disease. What is the next best step in management?
- Perioperative