Abscess Formation Secondary to Bowel Perforation as Initial Presentation of Crohn's Disease: A Case Report
DOI:
https://doi.org/10.24871/2622025184-187Keywords:
Abdominal abscess, crohn's disease, intestinal perforationAbstract
Crohn's Disease is a gastrointestinal disorder that is more prevalent in the Asian population. Clinical features, such as diarrhea, abdominal pain, and hematochezia, are common manifestations of Crohn's Disease. A 23-year-old male patient presented with a 2-month history of abdominal pain and a mass-like appearance in the right flank. A colonoscopy was performed, which suggests Crohn's Disease. Abdominal CT scan revealed abscess formation. Clinical improvement was not achieved despite the optimization of 5-ASA treatment and the addition of steroids. Abscess drainage was performed, which later revealed ileo-colon perforation with severe adhesion, which was treated with ileo-colon resection, followed by double barrel ileo-colostomy. The pain was improved after surgery and optimization of 5-ASA, steroids, and azathioprine. Intestinal abscess formation should be considered one of the manifestations of Crohn's Disease, which also needs to be investigated for possibilities of perforation. Adequate surgical and medical management can be used to achieve and maintain remission and prevent another intestinal complication. This case report aims to raise awareness of intestinal abscesses due to bowel perforation in Crohn's disease patients.
References
Feuerstein JD, Cheifetz AS. Crohn disease: epidemiology, diagnosis, and management. Mayo Clin Proc. 2017;92(7):1088-103.
Cushing K, Higgins PDR. Management of Crohn disease: a review. JAMA. 2021 Jan 5;325(1):69-80.
Majewska K, Rusinowski C, Jablonska B, Golka D, Mrowlec S. Retrospective study of surgical outcomes in 60 patients with Crohn disease from a single center in Poland. Med Sci Monit. 2022;28:e934463.
Luglio G, Cassese G, Amendola A, Rispo A, Maione F, De Palma GD. Novel approaches to ileocolic and perianal fistulising Crohn’s disease. Gastroenterol Res Pract. 2018;2018:3159543.
Rubbino F, Greco L, Di Cristofaro A, Gaiani F, Vetrano S, Laghi L, et al. Journey through Crohn’s disease complication: from fistula formation to future therapies. J Clin Med. 2021;10(23):5548.
Haas M, Treton X, Stefanescu C, Bouhnik Y. Intra-abdominal abscesses in Crohn’s disease – when to treat with biologics? United European Gastroenterol J. 2022;10:1085-90.
Tadesse R, Ewnte B, Tesfaye K. Perforated ileum as the initial presentation of Crohn’s disease: a case report. Int J Surg Case Rep. 2022;97:107305.
Richards RJ. Management of abdominal and pelvic abscess in Crohn’s disease. World J Gastrointest Endosc. 2011 Nov 16;3(11):209-12.
Kayar Y, Baran B, Ormeci AC, Akyuz F, Demir K, Besisik F, et al. Risk factors associated with progression to intestinal complications of Crohn disease. Chin Med J (Engl). 2019;132(20):2423-9.
Carvalho ATP, Esberard BC, Moreira AL. Current management of spontaneous intra-abdominal abscess in Crohn’s disease. J Coloproctol (Rio J). 2016. Available from: http://dx.doi.org/10.1016/j.jcol.2016.05.003
Feagins LA, Holubar SD, Kane SV, Spechler SJ. Current strategies in the management of intra-abdominal abscesses in Crohn’s disease. Clin Gastroenterol Hepatol. 2011 Oct;9(10):842-50.
De Groof EJ, Carbonnel F, Buskens CJ, Bemelman WA. Abdominal abscess in Crohn’s disease: multidisciplinary management. Dig Dis. 2014;32(Suppl 1):103-9.
Waked B, Holvoet T, Geldof J, Baert F, Pattyn P, Lobaton T, et al. Conservative management of spontaneous intra-abdominal abscess in Crohn’s disease: outcome and prognostic factors. J Dig Dis. 2021 May;22(5):263-70.
Pal P, Kanaganti S, Banerjee R, Ramchandani M, Nabi Z, Reddy DN, et al. Systematic review of endoscopic management of stricture, fistula and abscess in inflammatory bowel disease. Gastroenterol Insights. 2023;14(1):45-63.
Shen B. Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn’s disease. Gastroenterol Rep (Oxf). 2022;10:goac045.
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