Prevention of Postoperative Recurrence in Crohn's Disease

A 29-year old man with Crohn's disease undergoes an ileocolic resection to treat an intra-abdominal abscess. The patient was diagnosed the year before with ileal Crohn's disease and was treated with mesalamine and budesonide. Several months before the operation the patient developed progressive symptoms of right lower-quadrant pain and fevers. A computerized tomography scan of the abdomen and pelvis showed marked wall thickening of the distal ileum and a 4-cm fluid collection in the right pelvis along with adjacent mesenteric fat stranding. The pelvic abscess was surrounded by several loops of bowel and therefore was not drainable through a percutaneous approach. The patient was treated with antibiotics, but his symptoms persisted and the abscess did not decrease in size on a repeat computerized tomography scan. The patient underwent a laparoscopic ileocolic resection. The pelvic inflammatory mass along with all of the diseased distal 45 cm of terminal ileum and the normal-appearing cecum were resected, and a stapled side-to-side anastomosis was created. The surgical specimen was notable for deep fissuring ulcerations and creeping fat, and on microscopy there was moderately severe acute and chronic inflammation with poorly formed granuloma. The proximal and distal margins of the surgical specimen were free of disease on both gross and microscopic inspection. The patient has an uneventful postoperative recovery and was discharged home 5 days after the surgery. He is otherwise in excellent health and he does not use tobacco.

Abbreviations used in this paper: 6-MP, 6-mercaptopurine, TNF, tumor necrosis factor