It’s What’s Up Front That Counts—Part Two: Esophageal Crohn’s Disease Complicated by Recurrent Upper Gastrointestinal Bleeding
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A 49-year-old woman with stricturing and penetrating ileocolonic Crohn’s disease (CD) complicated by rectosigmoid and anal strictures, perianal fistula, as well as recurring rectovaginal fistula was evaluated for complaints of mild esophageal dysphagia.
The patient was initially diagnosed with CD at age 29 when she developed diarrhea and a perianal fistula. Following loss of response to azathioprine and mesalamine, standard dose infliximab was initiated in 2006. Shortly thereafter, she was diagnosed with a rectovaginal fistula in the setting of passing gas and small amounts of stool through her vagina after which the infliximab dose was optimized. She underwent three balloon dilations for a tight rectal stricture but remained otherwise clinically well until 2011 when her rectovaginal fistula returned subsequent to delivering a healthy child via cæsarean section. Although colorectal surgery was consulted, they deferred advancement flap surgery due to...