Raising the Barr: An Unexpected Lesion at Ileal–Cecal Resection
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A 24-year-old man with stricturing, ileocolonic Crohn’s disease with recent partial small bowel obstruction (SBO) due to terminal ileal stenosis, was evaluated 1 day prior to previously scheduled elective ileocecal resection with complaints of fevers, myalgias, and fatigue.
His Crohn’s diagnosis occurred at age 13 (2006) when he was first evaluated with complaints of diarrhea and weight loss for the prior month. The initial diagnostic colonoscopy demonstrated inflammatory changes characterized by superficial and deep ulcerations with luminal narrowing in the terminal ileum and ascending colon. Initiation of infliximab in 2007 led to clinical remission until 2011 when response to the treatments waned. A switch to certolizumab in 2011 recaptured clinical remission until 2017 when he began to experience breakthrough symptoms. He was ultimately switched to adalimumab in 2017, which required titration from every other week to every 10-day dosing in order to...
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Conflict of interest
The authors do not have any relevant conflicts of interest with respect to this case presentation.