• 2014 --- Increased frequency of SAIO
• Surgery – (15/01/2014): Lap CCx + ileocaecal & ileal resection with ileo-ascending anastomosis.
Op findings
– Thin walled distended GB with multiple calculi
– Long segment distal ileal stricture (2 feet) with fat creeping
– Stricture extending till IC junction
– Omentum densely adherant to caecum & abdominal wall
Complicated (21/01/2014) --- Re-exploration
– Ascending colonic gangrene near anastomotic site with fecal peritonitis (Rt lower abdomen)
June 2014
• Restoration surgery for ileo-colonic continuity + adhesiolysis
• Biopsy – benign stricture with focal mucosal ulcerations with foci of fissure like ulceration with mild crypt disarray, submucosal fibrosis & transmural inflammation with focal fat wrapping, no granulomas --- Crohn’s disease > CMUSE
• Started on 5-ASA and Azathioprine --- Continued till 2020
• Regular follow-up & treatment compliant
• Minor flares over past 6 yrs
• No steroids / biologics
• Symptomatic since Oct 2020 --- abdominal pain, bilious vomiting's – Recurrent SAIO
• CBC, RFT, LFT – Normal
• Fecal calprotectin - 384 mg/kg
• Colonoscopy - circumferential ulceration at anastomotic site but no narrowing, aphthous ulcers with mucosal edema at neo-terminal ileum, no stenosis
• CECT – Dilated jejunal loops, collapsed loops of terminal ileum with narrowing in neo-terminal ileum -? due to adhesions
18/12/2020
29/12/2020
This patient is a complicated stricturizing Crohn's disease with recurrent SAIO due to probable adhesions and strictures. The patient requires step up therapy in the form of Biologics. Also diet management in the form of low residue diet is must.