Case Study of Complicated Crohn's Disease: Emphasizing the Role of Imaging in Outcome Improvement

Vasile-Claudiu Mihai

Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, Romania

^*Correspondance to: Vasile-Claudiu Mihai 

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Abstract:

Crohn’s Disease (CD) is a chronic inflammatory disease of the digestive tract, exhibiting a recurrentremissive pattern. Its management requires a skilful integration of clinical, biological and imaging methods to obtain disease control. We present the case of a 46-year-old male diagnosed with stenosing CD ten years ago. The initial presentation was due to intestinal occlusion, for which he underwent right hemicolectomy. The colonoscopy performed at six months post-operatively revealed disease recurrence, which imposed the induction of biologic therapy (initially Adalimumab, followed by Infliximab). Complete remission was maintained for ten years as demonstrated by the clinical, paraclinical, colonoscopy and imaging examinations. In February 2023, the patient was admitted for a flare. Abdominal Computed Tomography (CT) revealed the site of inflammation and excluded complications, so the decision was to intensify the Anti-Tumour Necrosis Factor (TNF) therapy. Worsening symptoms led to the patient’s readmission, but this time the CT showed inflammatory stenosis of the sigmoid colon and two pericolic air-fluid collection. Multidisciplinary consultation decided for conservatory management with the association of antibiotics and cortisone. Favourable evolution was confirmed by abdominal US, showing the resolution of the pericolic collection. The pathogenic treatment was changed to Ustekinumab, leading to complete remission (clinical, paraclinical and imaging). The presented case demonstrates the prolonged evolution of a patient with complicated CD, for which the multidisciplinary approach was the key to success. High quality imaging is essential for activity monitoring, evaluation of treatment response and diagnosing complications in inflammatory bowel disease patients.

Keywords:

Crohn’s disease; Abdominal imaging; Abscess; Complicated inflammatory bowel disease; IUS

Cite the Article:

Vasile-Claudiu Mihai. Case Study of Complicated Crohn's Disease: Emphasizing the Role of Imaging in Outcome Improvement. Ann Clin Case Rep. 2024; 9: 2700..