Crohn’s Disease 19 Years After Initial Resection

Abstract

Four years after a bowel resection for Crohn’s disease (Case 56), this patient was admitted to hospital with a 2 week history of lower abdominal pain and alternating diarrhea and constipation. A tender mass was present in the right iliac fossa. A small bowel contrast series showed fixed loops of dilated small bowel indicative of “mild obstruction” (Figure 57.1). Recurrent Crohn’s of the small bowel was diagnosed and treatment with prednisolone initiated. The patient’s reasonable progress over the next 15 years was interrupted by 3 significant episodes of small bowel obstruction. Radiological investigations demonstrated 2 or 3 small bowel strictures with evidence of chronic obstruction (Figure 57.1). Colonoscopy was normal up to and including the ileocecal valve. The patient now agreed to surgical treatment.