A CASE OF CHALLENGING DIAGNOSIS OF CROHN'S DISEASE WITH POST-RESECTION RECURRENCE AS A RESULT OF IRRATIONAL POSTOPERATIVE MANAGEMENT STRATEGY

Abstract

We present a clinical example of a complex diagnosis of Crohn's disease with an isolated lesion of the terminal ileum (terminal ileitis). The disease was complicated by stenosis of the ileum (8 cm) with its subsequent resection. Further lack of the patient’s follow-up and inadequate therapy choice led to a relapse of the disease. The recurrence was diagnosed with video capsule endoscopy that revealed linear ulcerative defects and stenosis in the distal ileum, passable for the video capsule. Prescription of biological therapy with Infliximab contributed to a convincing clinical and laboratory remission.The article highlights the basic and debatable issues on management strategies and the choice of anti-relapse therapy for the patients with Crohn's disease in postoperative period, depending on clinical situation. This case illustrates the difficulties of Crohn's disease diagnosis in asymptomatic patients, success of biological therapy, and significance of proper postoperative management. We demonstrate how a deviation from the standardized clinical algorithm in the postoperative period caused the recurrence of terminal ileitis with the formation of ileal stenosis.