To Continue ATT or Treat as Crohns' Disease?

- A 31 year old male with no known comorbidities

- Abdominal pain-diffuse in nature along with abdominal distention, 3 episodes of non feculent vomiting as well low grade documented fever since 3 days

- On examination-Distended abdomen with tenderness on the right hypochondrium area

- Laboratory examination/ultrasound-unremarkable

- In view of rapid onset symptoms patient underwent an Contrast enhanced CT alongwith inspection of the bowel with an colonoscope

- Colonoscopy-Deformed Ceacum/IC valve with ulcerations(scope not passed beyond)

- Biopsy – Active granulomatous colitis –Koch>CD

- MTB –PCR –Positive

- CT Imaging-Edematous thickened ileal loops with focal air pockets noted 30 cm from the terminal ileum -? Pneumoperitonium

- In view of continued symptoms and possibility of pneumoperitonium the patient underwent an emergency laparotomy with segmental resection and double barrel stroma

- Post op-unremarkable

- Patient was discharged on day 8 post op with ATT (HRZE)

- Post Surgical specimen – focal ulceration, necrosis, granulation tissue with no evidence of Granulomas/IBD