Incidental small bowel malignancy in a chronic ileal stricture in a patient with Crohn's disease: an interesting case

2020 ◽  
Author(s):  
Ji Chen ◽  
Nagy Andrawis
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Interesting Case ◽  
Ileal Stricture ◽  
Small Bowel Malignancy

scholarly journals P169 Balloon enteroscopy in small bowel Crohn’s disease (CD) with suspected bleeding

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S222-S222
Author(s):  
N M LAW
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Therapeutic Intervention ◽  
Definitive Diagnosis ◽  
Gi Bleeding ◽  
Ileal Stricture ◽  
Single Operator ◽  
Small Bowel Bleeding

Abstract Background Deep enteroscopy with Single Balloon Enteroscopy (SBE) has been used in the evaluation of small bowel diseases and could be performed by a single operator. The role and safety of SBE in suspected small bowel CD with bleeding remained uncertain. Our primary aim was to evaluate the role of SBE in the management of suspected small bowel Crohn’s Disease (CD) with bleeding. The secondary aim was to find out whether SBE could provide definitive diagnosis and therapeutic intervention. Methods Hospitalised patients with iron deficiency anaemia (IDA) and/or overt GI bleeding were studied. All had prior negative oesophagogastro-duodenoscopy (OGD) and colonoscopy followed by single operator SBE. The indications were IDA in 28 patients, overt GI bleeding in 18 patients and IDA with abdominal pain and/or weight loss in 6 patients. Twenty and six patients had CT scan and capsule endoscopy done respectively with normal or unconfirmed small bowel lesions. Results Fifty-two patients with suspected small bowel bleeding were studied with mean age of 51 (range 20 -84) years. Small bowel Crohn’s disease were diagnosed in 7 patients with jejunal and ileal involvement in 2 and 5 patients respectively. All patients had subsequent histopathology confirmation from biopsies taken during the procedures. In addition, SBE allowed the retrieval of a stuck capsule scope in a patient with proximal ileal stricture. Repeated balloon dilatation through SBE was done successfully in one patient with distal ileal stricture without complication. Conclusion Small bowel Crohn’s disease was found in 21% of our patients with suspected small bowel bleeding. SBE is the preferred method of small bowel evaluation after negative upper and lower GI evaluation in this selected patients. Definitive diagnosis and targeted biopsies confirmed the diagnosis of CD as compared with radiological imaging and capsule endoscopy. SBE also provided safe therapeutic intervention in those patients with small bowel stricture from CD through endoscopic dilatation.

Small-bowel lymphoma complicating long-standing Crohn's disease.

1997 ◽  
Vol 169 (5) ◽  
pp. 1462-1463 ◽  
Author(s):  
H E Woodley ◽  
J A Spencer ◽  
K A MacLennan
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease

P084 DEEP REMISSION WITH DOUBLE BIOLOGIC THERAPY: A SUCCESSFUL CASE OF COMBINATION USTEKINUMAB AND VEDOLIZUMAB FOR SEVERE REFRACTORY CROHN’S DISEASE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S72-S72
Author(s):  
Ahmed Elmoursi ◽  
Courtney Perry ◽  
Terrence Barrett
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Clinical Remission ◽  
Biologic Therapy ◽  
Case Reports ◽  
Sigmoid Resection ◽  
Safety And Efficacy ◽  
Ileal Stricture

Abstract Background Stricturing Crohn’s disease (CD) constitutes a severe phenotype often associated with a high degree of morbidity (3). Surgical resection is first-line therapy for symptomatic strictures, but most patients relapse without subsequent medical therapy (4–5). Biologics are the mainstay for inducing and maintaining remission, but some cases are refractory despite maximum dosage of therapy. Reports of dual biological therapy (DBT) in refractory, stricturing CD are sparse, and prior case reports document only clinical remission (1). To contribute further knowledge regarding the use of DBT in stricturing CD, we present the case of a refractory CD patient who achieved deep remission with ustekinumab and vedolizumab. Case Presentation A 35 year old non-smoking, Caucasian male was referred to our clinic in 2014 for refractory CD complicated by multiple strictures. Prior to establishing care with us, he received two jejunal resections and a sigmoid resection. Previously failed therapies included azathioprine with infliximab, adalimumab, and certolizumab. He continued to progress under our care despite combination methotrexate/certolizumab, as well as methotrexate/golimumab. He underwent proctocolectomy with end ileostomy in 2015 and initiated vedolizumab q8weeks post-operatively. He reoccurred in 2018, when he presented with an ulcerated ileal stricture. He was switched from vedolizumab to ustekinumab q8weeks and placed on prednisone, but continued to progress, developing significant hematochezia requiring hospitalization and blood transfusions. Ileoscopy performed during hospital admission confirmed severe, ulcerating disease in the ileum with stricture. Ustekinumab dosing was increased to q4weeks, azathioprine was initiated, and he underwent stricturoplasty. Follow-up ileoscopy three months later revealed two ulcers in the neo- TI (Figure 1). Vedolizumab q8weeks was initiated in addition to ustekinumab q4weeks and azathioprine 125mg. After four months on this regimen the patient felt better, but follow-up ileoscopy showed two persistent ulcers in the neo-TI. Vedolizumab dosing interval was increased to q4weeks. After four months, subsequent ileoscopy demonstrated normal neo-TI (Figure 2). Histologic evaluation of biopsies confirmed deep remission of crohn’s disease. No adverse side effects have occurred with maximum doses of both ustekinumab and vedolizumab combination therapy. Discussion This case supports both the safety and efficacy of ustekinumab and vedolizumab dual biologic therapy for treatment of severe, refractory Crohn’s disease. While there are reports of DBT inducing clinical remission, this case supports efficacy for vedolizumab and ustekinumab combination therapy to induce deep histologic remission. Large practical clinical trials are needed to better investigate the safety and efficacy of DBT with vedolizumab and ustekinumab, but our case suggests this combination may be a safe and efficacious therapy for refractory CD patients.

Apex Score: Predicting Flares in Small-Bowel Crohn’s Disease After Mucosal Healing

2021 ◽  
Author(s):  
Vítor Macedo Silva ◽  
Marta Freitas ◽  
Pedro Boal Carvalho ◽  
Francisca Dias de Castro ◽  
Tiago Cúrdia Gonçalves ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Mucosal Healing
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