Large Bowel Obstruction: Crohn’s Disease

Abstract

In 1976, the patient presented with a 9-month history of diarrhea and anal discharge. Sigmoidoscopy to 20cm revealed an anterior anal fissure and a mild patchy proctitis. A barium enema demonstrated a long stricture of the descending colon with almost complete obstruction “due to advanced Crohn’s disease” (Figure 58.1). Rectal biopsies were consistent with this diagnosis. Over the next 9 months, the patient was treated with oral prednisolone, resulting in intermittent improvement. In April 1977, a cautious barium enema showed persistence of the stricture and gross dilation of the transverse colon (Figure 58.2). Elective operation was arranged but was superceded by urgent admission due to acute bowel obstruction and signs of peritonitis.