Crohn's Disease with Repeated Early Recurrences After Operations, Report of a Case N. Kohrogi 1 , M. Iida 1 , T. Fuchigami 1 , S. Tohdoh 2 , S. Ikeda 2 1The Second Department of Internal Medicine, Faculty of Medicine, Kyushu University 2The First Department of Surgery, Faculty of Medicine, Kyushu University pp.321-326
Published Date 1984/3/25
DOI https://doi.org/10.11477/mf.1403106981
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 A 20 year-old man was admitted to our hospital with lower abdominal pain, fever and weight loss of two years' duration on May 26,1975. On admission, physical examination disclosed perineal fistulae without abdominal tenderness or mass. He was diagnosed as having Crohn's disease by means of barium enema study and colonoscopy.

 He was treated with corticosteroids, sulfasalazine, metronidazole and/or total parenteral nutrition, but did not achieve a complete remission. He underwent right hemicolectomy with terminal ileal resection in June 1979. Intraoperative endoscopy revealed no abnormality in the retained small intestine. Histopathologically, the diagnosis was confirmed and the resected bowel margins were free of the disease. Seven days later, he complained of diarrhea and abdominal pain. Forty-two days after the operation, colonoscopy proved recurrence at the anastomosis.

 In January 1980, reoperation was done for adhesion ileus and the diseased segment was resected. But, 40 days after the second operation, colonoscopy revealed recurrence of the disease at the anastomosis.

 Thereafter, perineal fistulae and perianal abscess gradually deteriorated and medical treatment became ineffective. He had resection of the diseased intestinal segment with ileostomy and fistulotomy in May and rectal amputation, fistulectomy and cholecystectomy in September 1982.

 In March 1983, endoscopy via ileostomy disclosed longitudinal ulcers in the ileum.

 He is now suffering from external fistulae of the peri-ileostomy region under hospitalization.

 The clinical course of the patient suggests that treatment of patients with Crohn's disease should be medical as possible and indications for surgery should be more restrictive because of high recurrence rate following surgery.

Copyright © 1984, Igaku-Shoin Ltd. All rights reserved.


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