73 Yrs Male with Hypertension, Chronic obstructive pulmonary disease (COPD), Dilated cardiomyopathy (DCM)

• Presented intermittent pain abdomen a/w abdominal distension, nausea since 6 months

• h/o weight loss ~10kg/6m

• 2-3 semisolid to liquid stools, uses laxatives, no blood or mucous

o/s evaluation

Colonoscopy

• Terminal ileal stricture at 5 cm from IC valve, scope not negotiable -? IBD – CD / kochs

• Bx – non specific ileitis, MTB PCR => Negative

MRI enterography

• Long segment ileal thickening with luminal narrowing

• Ileo vescical fistula

• Started on Pentasa and Budez- CR

• patient presented to us with abdominal distension and pain , constipation à treated conservatively , passed flatus, stools not passed

CBC - 10.2/12200/4.9

S.CREATNINE - 1.0

LFT - 0.5/0.1

ESR - 26

cue - Plenty of pus cells => E.COLI

Issues

• Elderly male with comorbidities and moderate LV dysfunction (LVEF 42%)

• Fistuliuzing crohns disease with recurrent SAIO

• Urinary tract infection (preclude BIOLOGICS)

• SURGERY => high risk because of co-morbidities