AB141. SOH23ABS_131. Surgical management of Crohn’s disease, case report and review of literature

Background: Crohn’s disease (CD) is idiopathic, chronic regional enteritis that most commonly affects the terminal ileum, but has the potential to affect any part of the gastrointestinal tract. The incidence and prevalence of CD is rising globally, with yearly increase in incidence ranging from 4% to 155% over the past three decades. We report a case of newly discover CD that presented with complications.

Case Presentation: We report a 22-year-old man, presented to emergency department with right iliac fossa pain (RIF), and elevated inflammatory markers. A CT scan showed terminal ilium inflammation and a suspicion of CD was raised. He had no background medical history. His case was discussed with gastroenterologist who suggested starting him on Budesonide. He was discharged home in a good condition with out-patient colonoscopy appointment. However, he was readmitted after 8 weeks with the same RIF pain and tenderness, in this occasion he had a clinically palpable RIF mass. The CT scan showed perforated terminal ileum loop and intra-peritoneal collection that communicated with anterior abdominal wall collection. His case was discussed with specialised colorectal service, surgical intervention was deferred, and he proceeded to have ultrasound guided drainage of the collection after. He is actively being followed up.

Conclusions: There are many options and cross roads in the decision making for surgery in CD. Differed surgery is the preferred option in adult patients with CD presenting with intestinal obstruction without bowel ischemia or peritonitis. The key to success in managing CD is a multidisciplinary team approach.

Keywords: Crohn’s disease (CD); terminal ileum; perforation; abdominal collection; case report