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Case Series in Crohn's Disease (cd) – With Different Surgical Approaches

Year: 2024

Type: article

Abstract: Case Presentation Case 1 – Male patient, 45 years old, BMI 20 kg/m², presenting with abdominal pain, weight loss, melena, and chronic diarrhea, already diagnosed with Crohn's Disease (CD) 20 years ago, undergoing irregular infliximab treatment. Enterotomography: Multiple areas of substenosis in the small intestine and areas of stenosis with partial concentric circumferential thickening in the distal ileum, with signs of intestinal obstruction upstream. Underwent stenoplasty of the substenosis areas and segmental enterectomy for stenosis of 20 cm of distal ileum, 15 cm from the ileocecal valve (ICV), with primary anastomosis. Case 2 – Female patient, 59 years old, BMI 22 kg/m², presenting with abdominal pain, watery diarrhea, and fever, undergoing irregular treatment with Adalimumab. Colonoscopy performed up to the sigmoid colon showing multiple serpiginous ulcers with fibrin, associated with stenosis, which prevented progression of the device. Enterotomography: stenosing thickening in the distal third of the transverse colon extending to 7.5 cm and two fistulous tracts to the left flank and greater gastric curvature. Underwent segmental colectomy of the stenotic area in the splenic flexure of the colon with manual end-to-end primary anastomosis. Case 3 – Male patient, 18 years old, BMI 18 kg/m², presenting with right iliac fossa pain, fever, anemia, and weight loss, who underwent appendectomy in an emergency service, with worsening obstructive symptoms. After this episode, further investigation and diagnostic confirmation of CD were performed. Colonoscopy up to the cecum showed a fixed angulation at the ileocecal valve, preventing examination of the terminal ileum. Abdominal CT: Parietal thickening with contrast enhancement and dilation upstream of the small bowel loops. Underwent right hemicolectomy with distal ileum enterectomy of about 40 cm, with terminal ileostomy formation. All three cases had good post-operative outcomes. Discussion The heterogeneous behavior and location of Crohn's Disease provides a variety of surgical treatments using different techniques, as well as endoscopic and radiological approaches, influenced by the nutritional status and adherence to medication. Conclusion Multidisciplinarity is the foundation in managing Crohn's Disease. Surgical treatment as an initial therapeutic approach, with its multiple variations depending on the affected intestinal segment, has been a successful alternative. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Source: Journal of Coloproctology

DOI: 10.1055/s-0045-1808732